Provider Demographics
NPI:1508808437
Name:ELSTEIN, MARK PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PAUL
Last Name:ELSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 W BROAD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1110
Mailing Address - Country:US
Mailing Address - Phone:215-536-8133
Mailing Address - Fax:215-529-9498
Practice Address - Street 1:1402 W BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1110
Practice Address - Country:US
Practice Address - Phone:215-536-8133
Practice Address - Fax:215-529-9498
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017798L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0531229Medicaid
120876OtherMEDICARE
PA0531229Medicaid