Provider Demographics
NPI:1720291917
Name:AGILINA, ELENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:AGILINA
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 1:9 JAYHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1243
Mailing Address - Country:US
Mailing Address - Phone:732-239-5672
Mailing Address - Fax:
Practice Address - Street 1:288 STATE ROUTE 35 S
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2105
Practice Address - Country:US
Practice Address - Phone:732-542-7770
Practice Address - Fax:732-542-4244
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice