Provider Demographics
NPI:1053764209
Name:DR ELAYNE SMITHEN RAMOS, DMD, PC
Entity type:Organization
Organization Name:DR ELAYNE SMITHEN RAMOS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHEN RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-742-4999
Mailing Address - Street 1:6227 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5645
Mailing Address - Country:US
Mailing Address - Phone:215-742-4999
Mailing Address - Fax:267-388-8882
Practice Address - Street 1:6227 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5645
Practice Address - Country:US
Practice Address - Phone:215-742-4999
Practice Address - Fax:267-388-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026036420010Medicaid