Healthcare Provider Details

I. General information

NPI: 1871423616
Provider Name (Legal Business Name): ELIAS BESHARA KHAWAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELIE KHAWAM DMD

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 CENTER ST
MENTOR OH
44060-2467
US

IV. Provider business mailing address

3140 NORTHWOOD LN
WESTLAKE OH
44145-3720
US

V. Phone/Fax

Practice location:
  • Phone: 440-659-2211
  • Fax:
Mailing address:
  • Phone: 216-630-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: