Healthcare Provider Details

I. General information

NPI: 1922179217
Provider Name (Legal Business Name): STEVEN TOUFIK ELKHAL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15925 SE STARK ST
PORTLAND OR
97233-3525
US

IV. Provider business mailing address

4117 SW 5TH DR
GRESHAM OR
97030-6427
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-0291
  • Fax: 503-253-1096
Mailing address:
  • Phone: 503-724-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD8724
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60215887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: