Provider Demographics
NPI:1104643618
Name:MOREL, ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MOREL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 IRONWORKS AVE APT 441
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2075
Mailing Address - Country:US
Mailing Address - Phone:703-881-1721
Mailing Address - Fax:
Practice Address - Street 1:103 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2209
Practice Address - Country:US
Practice Address - Phone:574-674-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014574A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist