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General NPI Number Information
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NPI Number | 1215128988
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Entity Type | Organization
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Legal Business Name | MAHR ELDER DDS MD P C
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1805 NOVATO BLVD SUITE 1
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City | NOVATO
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State | CA
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Zip | 94947-2934
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Country | US
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Telephone | 415-892-1190
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Fax | 415-892-7355
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Provider Business Mailing Address
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Address Line | 1805 NOVATO BLVD SUITE 1
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City | NOVATO
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State | CA
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Zip | 94947-2934
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Country | US
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Telephone | 415-892-1190
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Fax | 415-892-7355
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHR FAIRUKE ELDER
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Credential | DDS, MD
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Telephone | 415-892-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D46586
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License Number State | CA
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