Provider Demographics
NPI:1831578194
Name:ELIAS, KATHY L (DMD, PHD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:ELIAS
Suffix:
Gender:
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3286
Mailing Address - Country:US
Mailing Address - Phone:313-563-1860
Mailing Address - Fax:
Practice Address - Street 1:6655 TRAVIS STREET
Practice Address - Street 2:SUITE 460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307191223X0400X
MI29010224181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics