Provider Demographics
NPI:1013962893
Name:ELMORE, AFSOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:AFSOON
Middle Name:
Last Name:ELMORE
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 1:2715 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2005
Mailing Address - Country:US
Mailing Address - Phone:407-260-0669
Mailing Address - Fax:407-629-0031
Practice Address - Street 1:2715 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2005
Practice Address - Country:US
Practice Address - Phone:407-260-0669
Practice Address - Fax:407-629-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075545100Medicaid