Healthcare Provider Details

I. General information

NPI: 1902749542
Provider Name (Legal Business Name): ELAHEH VAHAB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5065
  • Fax:
Mailing address:
  • Phone: 502-852-5065
  • Fax: 502-852-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD-00260
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: