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General NPI Number Information
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NPI Number | 1396800173
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Entity Type | Individual
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Provider Name | ISMAIL IBRAHIM ELSHERIF D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 4550 N LARK ELLEN AVE STE 104
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City | COVINA
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State | CA
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Zip | 91722-3147
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Country | US
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Telephone | 626-331-8041
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Fax | 626-331-4082
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Provider Business Mailing Address
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Address Line | 4550 N LARK ELLEN AVE STE 104
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City | COVINA
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State | CA
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Zip | 91722-3147
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Country | US
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Telephone | 626-331-8041
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Fax | 626-331-4082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47883
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 47883
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License Number State | CA
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