Provider Demographics
NPI:1558979468
Name:MCCOLLUM, ELISE ESPOSITO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:ESPOSITO
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:CAITLIN
Other - Last Name:ESPOSITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-899-9591
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5798
Practice Address - Country:US
Practice Address - Phone:504-896-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD115521223G0001X
LA73991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice