Healthcare Provider Details

I. General information

NPI: 1407372899
Provider Name (Legal Business Name): SARA ELASHAAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

IV. Provider business mailing address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1817
  • Fax:
Mailing address:
  • Phone: 202-279-1817
  • Fax: 202-617-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1001768
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: