Provider Demographics
NPI:1366589103
Name:PHILLIP ELMO D.D.S., INC.
Entity type:Organization
Organization Name:PHILLIP ELMO D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, AAFP
Authorized Official - Phone:614-798-0083
Mailing Address - Street 1:5155 BRADENTON AVE
Mailing Address - Street 2:STE #110
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7558
Mailing Address - Country:US
Mailing Address - Phone:614-798-0083
Mailing Address - Fax:614-764-9184
Practice Address - Street 1:5155 BRADENTON AVE
Practice Address - Street 2:STE #110
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7558
Practice Address - Country:US
Practice Address - Phone:614-798-0083
Practice Address - Fax:614-764-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty