Provider Demographics
NPI:1689794885
Name:TOBON, ELIAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:TOBON
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 1:144 NE 43RD ST
Mailing Address - Street 2:APT #1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3412
Mailing Address - Country:US
Mailing Address - Phone:305-529-9595
Mailing Address - Fax:305-529-5190
Practice Address - Street 1:401 MIRACLE MILE
Practice Address - Street 2:SUITE 109
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-529-9595
Practice Address - Fax:305-529-5190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14672122300000X
FLDN 146721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics