Healthcare Provider Details

I. General information

NPI: 1629025960
Provider Name (Legal Business Name): JAFFAR M ELAHI DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JEFF ELAHI

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 E RIGGS RD SUITE 109
SUN LAKES AZ
85248-7623
US

IV. Provider business mailing address

10325 E RIGGS RD SUITE 109
SUN LAKES AZ
85248-7623
US

V. Phone/Fax

Practice location:
  • Phone: 480-883-8000
  • Fax: 480-883-1147
Mailing address:
  • Phone: 480-883-8000
  • Fax: 480-883-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD4795
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: