Provider Demographics
NPI:1902925993
Name:ELIASZ, MICHAEL ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:ELIASZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5200 KELLER SPRINGS RD
Mailing Address - Street 2:#1132
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2723
Mailing Address - Country:US
Mailing Address - Phone:972-458-9240
Mailing Address - Fax:214-363-4295
Practice Address - Street 1:8215 WESTCHESTER DR
Practice Address - Street 2:SUITE 145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6103
Practice Address - Country:US
Practice Address - Phone:214-363-1603
Practice Address - Fax:214-363-4295
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14394OtherSTATE DENTAL LICENSE NUM.