Provider Demographics
NPI:1730548934
Name:EPANE KAMDEM, ELODIE CHIMUANYA (DDS)
Entity type:Individual
Prefix:
First Name:ELODIE
Middle Name:CHIMUANYA
Last Name:EPANE KAMDEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 1ST ST STE 650
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4423
Mailing Address - Country:US
Mailing Address - Phone:194-174-9174
Mailing Address - Fax:
Practice Address - Street 1:BRIGHT NOW DENTALST , 650
Practice Address - Street 2:3611 1ST STREET, SUIYR
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:194-174-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN22509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program