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Organization

MARIANA C ELWELL DDS FAGD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARIANA C ELWELL DDS (PRESIDENT)
(856) 455-4095
Entity
Organization

Contact information

Practice address
6 ATLANTIC ST, BRIDGETON, NJ 08302-1829
(856) 455-4095
(856) 455-5292
Mailing address
3129 COUNTRY LN, VINELAND, NJ 08361-8634
(856) 506-9351

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02582800
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1265421986
INDIVIDUAL NPI
Enumeration date
07/16/2018
Last updated
07/16/2018
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