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General NPI Number Information
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NPI Number | 1801335989
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Entity Type | Organization
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Legal Business Name | ANTHONY A. ELGOHARY, DMD, PLLC
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 5131 RIVER CLUB DR SUITE 220
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City | SUFFOLK
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State | VA
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Zip | 23435-3661
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Country | US
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Telephone | 757-484-4197
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Fax | 757-483-9065
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Provider Business Mailing Address
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Address Line | 5131 RIVER CLUB DR SUITE 220
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City | SUFFOLK
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State | VA
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Zip | 23435-3661
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Country | US
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Telephone | 757-484-4197
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Fax | 757-483-9065
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN LEE RICKS
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Credential |
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Telephone | 757-484-4197
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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 | 0401410824
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License Number State | VA
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