MEDICARE: ELEVATE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790467785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE DENTAL

Provider Business Mailing Address
First Line	:	1347 BURNING ARROW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2765
Country	:	US
Telephone Number	:	617-319-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 HARRY WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5543
Country	:	US
Telephone Number	:	210-824-3531
Fax Number	:	210-824-0068

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMAD ABDALLAH
Credential	:	DMD
Telephone Number	:	210-824-3531

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	05/27/2025

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Directions to “ELEVATE DENTAL ” Practice Location

Language	Start Address	Practice Location

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