Provider Demographics
NPI:1518939388
Name:ELSON, MARTIN T (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:T
Last Name:ELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6060
Mailing Address - Country:US
Mailing Address - Phone:401-464-6406
Mailing Address - Fax:401-464-6466
Practice Address - Street 1:1265 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6060
Practice Address - Country:US
Practice Address - Phone:401-464-6406
Practice Address - Fax:401-464-6466
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI25061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIME1187Medicaid
RIU44783Medicare UPIN