Elise Dedominicis, DDS is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Philadelphia, Pennsylvania. Her current practice location is
5501 Old York Rd, Philadelphia, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(215) 456-7890.
Elise Dedominicis is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184288581.
Healthcare Provider's Profile
Full Name | Elise Dedominicis |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 5501 Old York Rd, Philadelphia, Pennsylvania |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1184288581
- Provider Enumeration Date: 05/01/2019
- Last Update Date: 04/24/2025
Medicare PECOS Information:
- PECOS PAC ID: 4284966292
- Enrollment ID: I20191024000533
Medical Identifiers
Medical identifiers for Elise Dedominicis such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1184288581 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
122300000X | Dentist | DS042760 (Pennsylvania) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Elise Dedominicis is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Elise Dedominicis, DDS 2112 Webster St, Philadelphia, PA 19146-1235 Ph: () - | Elise Dedominicis, DDS 5501 Old York Rd, Philadelphia, PA 19141-3018 Ph: (215) 456-7890 |
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