Provider Demographics
NPI:1306197413
Name:MARTIN, ELAINE MASUCCI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MASUCCI
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 NEBRASKA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2131
Mailing Address - Country:US
Mailing Address - Phone:202-966-1900
Mailing Address - Fax:202-966-4078
Practice Address - Street 1:4347 NEBRASKA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2131
Practice Address - Country:US
Practice Address - Phone:202-966-1900
Practice Address - Fax:202-966-4078
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN 5181122300000X
MD10167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist