Provider Demographics
NPI:1942934914
Name:ELMEJDOUBI, DIJANA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DIJANA
Middle Name:
Last Name:ELMEJDOUBI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS
Mailing Address - Street 2:6940 MESA RIDGE PARKWAY
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1533
Mailing Address - Country:US
Mailing Address - Phone:719-229-4076
Mailing Address - Fax:
Practice Address - Street 1:FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS
Practice Address - Street 2:6940 MESA RIDGE PARKWAY
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1533
Practice Address - Country:US
Practice Address - Phone:719-229-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002055111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty