Healthcare Provider Details

I. General information

NPI: 1790101244
Provider Name (Legal Business Name): ANDREW ELMASRI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAMBERLEY
LAGUNA NIGUEL CA
92677-2942
US

IV. Provider business mailing address

2 CAMBERLEY
LAGUNA NIGUEL CA
92677-2942
US

V. Phone/Fax

Practice location:
  • Phone: 949-212-1543
  • Fax:
Mailing address:
  • Phone: 949-212-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number62252
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberGA1703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: