MEDICARE: ALAA ELAMIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401418591	VA

General Provider Information

NPI Number	:	1710762406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAA ELAMIN DDS

Provider Business Mailing Address
First Line	:	6399 RICHMOND RD STE 101
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6399 RICHMOND RD STE 101
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1729
Country	:	US
Telephone Number	:	757-707-1610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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