Provider Demographics
NPI:1154511376
Name:ELEFANT, JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:ELEFANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FEDERAL HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5185
Mailing Address - Country:US
Mailing Address - Phone:561-272-2424
Mailing Address - Fax:561-272-0232
Practice Address - Street 1:801 S FEDERAL HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5185
Practice Address - Country:US
Practice Address - Phone:561-272-2424
Practice Address - Fax:561-272-0232
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist