MEDICARE: ISLAM MOHAMED HASSAN ELKENAWY DDS MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	36676	TX

General Provider Information

NPI Number	:	1912511916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISLAM MOHAMED HASSAN ELKENAWY DDS MS

Provider Business Mailing Address
First Line	:	3815 EASTSIDE ST APT 7003
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3842
Country	:	US
Telephone Number	:	909-374-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4808
Country	:	US
Telephone Number	:	281-501-7550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	09/07/2020

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