Provider Demographics
NPI:1902524200
Name:ENDRES, ELISE TIGANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:TIGANI
Last Name:ENDRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELISE
Other - Middle Name:KATHERINE
Other - Last Name:TIGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3802 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3905 NATIONAL DR STE 170
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6102
Practice Address - Country:US
Practice Address - Phone:301-989-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty