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General NPI Number Information
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NPI Number | 1790926012
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Entity Type | Organization
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Legal Business Name | ELSHERIF DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/17/2009
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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 SUITE # 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 SUITE # 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 | PRESIDENT
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Name | DR. ISMAIL ELSHERIF
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Credential | DDS
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Telephone | 626-331-8041
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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 | 47883
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License Number State | CA
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