Provider Demographics
NPI:1700173143
Name:SMITHEN RAMOS, ELAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELAYNE
Middle Name:
Last Name:SMITHEN RAMOS
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 1:501 S 42ND ST
Mailing Address - Street 2:APT 3R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4401
Mailing Address - Country:US
Mailing Address - Phone:786-306-2649
Mailing Address - Fax:
Practice Address - Street 1:1727 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1527
Practice Address - Country:US
Practice Address - Phone:215-334-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist