Provider Demographics
NPI:1356775761
Name:NIEDELMAN, ELISHEVA (DMD)
Entity type:Individual
Prefix:DR
First Name:ELISHEVA
Middle Name:
Last Name:NIEDELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:APT E1505
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3601
Mailing Address - Country:US
Mailing Address - Phone:267-226-1358
Mailing Address - Fax:
Practice Address - Street 1:1215 THOMASVILLE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3478
Practice Address - Country:US
Practice Address - Phone:972-494-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS139515122300000X
TX335551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist