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General NPI Number Information
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NPI Number | 1053017681
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Entity Type | Organization
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Legal Business Name | ELGHOR DENTAL CORPORATION
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 4765 CARMEL MOUNTAIN RD STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92130-6657
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Country | US
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Telephone | 858-314-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 4765 CARMEL MOUNTAIN RD STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92130-6657
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Country | US
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Telephone | 858-314-3172
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARAH ELGHOR
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Credential | DDS
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Telephone | 763-568-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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