Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401410744 | VA |
NPI | 1043463169 |
---|---|
Provider Name | Dean Elattrache |
First Address | Virginia Beach, VA 23454 |
Second Address | Virginia Beach, VA 23454-5875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |