Healthcare Provider Details

I. General information

NPI: 1710380027
Provider Name (Legal Business Name): TAHANY WHITING-ELAKKAD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E GLENDALE AVE
PHOENIX AZ
85020-5348
US

IV. Provider business mailing address

1150 E GLENDALE AVE
PHOENIX AZ
85020-5348
US

V. Phone/Fax

Practice location:
  • Phone: 623-258-7418
  • Fax:
Mailing address:
  • Phone: 623-258-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9050
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: