Provider Demographics
NPI:1811440738
Name:VOLTIDI, ELENI
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:VOLTIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 LINDEN TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-4233
Mailing Address - Country:US
Mailing Address - Phone:504-230-9939
Mailing Address - Fax:
Practice Address - Street 1:8650 HUDSON BLVD N STE 105
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042
Practice Address - Country:US
Practice Address - Phone:504-230-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS1091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics