Individual
ELIDA LICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4710 GREAT NORTHERN BLVD, NORTH OLMSTED, OH 44070-3427
(216) 778-4486
Mailing address
21800 RIVER OAKS DR, ROCKY RIVER, OH 44116-3127
(216) 258-9243
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.027657
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2022
Last updated
11/25/2024
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