Healthcare Provider Details

I. General information

NPI: 1265459994
Provider Name (Legal Business Name): SABAH AHMEIDA ELMASOURI BDS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MEXICO ST
CAMDEN NY
13316
US

IV. Provider business mailing address

24 MEXICO ST
CAMDEN NY
13316
US

V. Phone/Fax

Practice location:
  • Phone: 315-245-4037
  • Fax: 315-245-4037
Mailing address:
  • Phone: 315-245-4037
  • Fax: 315-245-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0437831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: