Provider Demographics
NPI:1629281928
Name:MITCHELL L. ELIAS, DDS
Entity Type:Organization
Organization Name:MITCHELL L. ELIAS, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-575-4700
Mailing Address - Street 1:147 KONNER AVE
Mailing Address - Street 2:PO BOX 109
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9436
Mailing Address - Country:US
Mailing Address - Phone:973-575-4700
Mailing Address - Fax:973-575-7799
Practice Address - Street 1:147 KONNER AVE
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9436
Practice Address - Country:US
Practice Address - Phone:973-575-4700
Practice Address - Fax:973-575-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00968200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty