Provider Demographics
NPI:1659463776
Name:TEXEIRA, ELSA IRENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:IRENE
Last Name:TEXEIRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 23 HORACE HARDING EXPWAY
Mailing Address - Street 2:16N
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4272
Mailing Address - Country:US
Mailing Address - Phone:718-592-9258
Mailing Address - Fax:
Practice Address - Street 1:46 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-538-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335593Medicaid
NY168972OtherDORAL