Healthcare Provider Details

I. General information

NPI: 1841301371
Provider Name (Legal Business Name): MAHR F ELDER D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 NOVATO BLVD SUITE #1
NOVATO CA
94947-2934
US

IV. Provider business mailing address

140 ADMIRAL CALLAGHAN LN STE B
VALLEJO CA
94591-4005
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-1190
  • Fax: 415-892-7355
Mailing address:
  • Phone: 707-552-5644
  • Fax: 707-552-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number46586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: