Healthcare Provider Details

I. General information

NPI: 1891611521
Provider Name (Legal Business Name): ABDUL-RAHMAN MUSTAFA ELAYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 US-64 #100
EADS TN
38028
US

IV. Provider business mailing address

2066 US HIGHWAY 45 BYP S
TRENTON TN
38382-3507
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-2382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13138
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: