Provider Demographics
NPI:1699669481
Name:ELSASSER, DEVON NOELLE (DMD)
Entity type:Individual
Prefix:MISS
First Name:DEVON
Middle Name:NOELLE
Last Name:ELSASSER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12071 CLAYTON BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2398
Mailing Address - Country:US
Mailing Address - Phone:984-310-0020
Mailing Address - Fax:
Practice Address - Street 1:12071 CLAYTON BLVD # 102
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2398
Practice Address - Country:US
Practice Address - Phone:984-310-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice