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General NPI Number Information
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NPI Number | 1902585870
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Entity Type | Individual
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Provider Name | ISLAM SALEH ELDERBASHY DMD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 1194 BIG BETHEL RD
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City | HAMPTON
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State | VA
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Zip | 23666-1906
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Country | US
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Telephone | 757-239-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 SW 71ST TER APT 714
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City | DAVIE
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State | FL
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Zip | 33314-1118
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Country | US
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Telephone | 734-604-7471
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401418589
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License Number State | VA
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