Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 11583 | FL |
Y | 1223P0700X | Prosthodontist | 11583 | FL |
NPI | 1255356598 |
---|---|
Provider Name | Dr. Nidal S Elias |
First Address | Jacksonville, FL 32256-1883 |
Second Address | Jacksonville, FL 32256-1883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59-3051738 | FEDERAL TAX I. D. NUMBER (01) | FL |