Provider Demographics
NPI:1679094148
Name:ELEGANCE IN DENTISTRY
Entity Type:Organization
Organization Name:ELEGANCE IN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-617-0700
Mailing Address - Street 1:1 BELMONT AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1607
Mailing Address - Country:US
Mailing Address - Phone:610-617-0700
Mailing Address - Fax:610-617-3443
Practice Address - Street 1:1 WINDING DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2907
Practice Address - Country:US
Practice Address - Phone:215-883-0611
Practice Address - Fax:267-713-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty