Provider Demographics
NPI:1881205961
Name:MALE, ELIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIO
Middle Name:
Last Name:MALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 COPPER STONE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6257
Mailing Address - Country:US
Mailing Address - Phone:972-653-0983
Mailing Address - Fax:
Practice Address - Street 1:1365 BARROW ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5171
Practice Address - Country:US
Practice Address - Phone:325-480-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist