Healthcare Provider Details

I. General information

NPI: 1376480376
Provider Name (Legal Business Name): AYAH KHALED ELSHAER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S TRACY BLVD STE 170
TRACY CA
95376-9111
US

IV. Provider business mailing address

2229 THOMAS CT
BRENTWOOD CA
94513-5663
US

V. Phone/Fax

Practice location:
  • Phone: 209-836-5441
  • Fax:
Mailing address:
  • Phone: 925-759-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: