Provider Demographics
NPI:1740432913
Name:DE ROODE, ELAINE SIMONE (DDS)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SIMONE
Last Name:DE ROODE
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 1:745 CRANDON BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2509
Mailing Address - Country:US
Mailing Address - Phone:305-361-1077
Mailing Address - Fax:
Practice Address - Street 1:745 CRANDON BLVD APT 307
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2509
Practice Address - Country:US
Practice Address - Phone:305-361-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics