Individual
ELISE DEDOMINICIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7890
Mailing address
2112 WEBSTER ST, PHILADELPHIA, PA 19146-1235
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS042760
PA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
04/24/2025
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