Provider Demographics
NPI:1407684467
Name:MARCOTTE, ELENA (DMD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MARCOTTE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IL
Mailing Address - Zip Code:61256-0173
Mailing Address - Country:US
Mailing Address - Phone:224-766-6603
Mailing Address - Fax:
Practice Address - Street 1:845 S PERRYVILLE RD UNIT 127
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4340
Practice Address - Country:US
Practice Address - Phone:779-423-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035278122300000X
IADDS-10266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist