Provider Demographics
NPI:1629196431
Name:ELISHA, ELON T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELON
Middle Name:T
Last Name:ELISHA
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 1:33 CRESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1626
Mailing Address - Country:US
Mailing Address - Phone:908-688-0022
Mailing Address - Fax:
Practice Address - Street 1:1441 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3321
Practice Address - Country:US
Practice Address - Phone:908-688-0022
Practice Address - Fax:908-851-9079
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023301001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice