Provider Demographics
NPI:1255876017
Name:ELAN, SUBANITHA (DDS)
Entity type:Individual
Prefix:
First Name:SUBANITHA
Middle Name:
Last Name:ELAN
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:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:
Practice Address - Street 1:1212 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-3525
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-324-1643
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042006122300000X
NJ22DI02658100122300000X
FLDN222521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist