Healthcare Provider Details

I. General information

NPI: 1861168726
Provider Name (Legal Business Name): ANDREW ELMASRI DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25701 WOOD BROOK RD
LAGUNA HILLS CA
92653-7555
US

IV. Provider business mailing address

30262 CROWN VALLEY PKWY # B447
LAGUNA NIGUEL CA
92677-2364
US

V. Phone/Fax

Practice location:
  • Phone: 949-288-3401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MICHAEL ELMASRI
Title or Position: DENTIST ANESTHESIOLOGIST
Credential:
Phone: 949-288-3401