Individual
ELIMIN TEJADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
636 COLUMBIA RD, DORCHESTER, MA 02125-3416
(617) 825-9839
Mailing address
636 COLUMBIA RD, DORCHESTER, MA 02125-3416
(671) 825-9839
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DL14257
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36753
NONEXISTENT
—
Enumeration date
01/26/2020
Last updated
01/26/2020
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