Provider Demographics
NPI:1932296688
Name:ELICE, CRAIG (DMD,DS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:ELICE
Suffix:
Gender:M
Credentials:DMD,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PARTRIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1139
Mailing Address - Country:US
Mailing Address - Phone:401-943-7535
Mailing Address - Fax:
Practice Address - Street 1:1090 NEW LONDON AVENUE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-943-7535
Practice Address - Fax:401-463-5693
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI23861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPD-00520Medicaid