Healthcare Provider Details

I. General information

NPI: 1083787055
Provider Name (Legal Business Name): EKBAL H. ELKADRY, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 HANCOCK ST UNIT #101
QUINCY MA
02169-5107
US

IV. Provider business mailing address

1372 HANCOCK ST UNIT #101
QUINCY MA
02169-5107
US

V. Phone/Fax

Practice location:
  • Phone: 617-472-3919
  • Fax: 617-770-2329
Mailing address:
  • Phone: 617-472-3919
  • Fax: 617-770-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EKBAL H ELKADRY
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 617-472-3919