Provider Demographics
NPI:1447500053
Name:SALEH ELAHWAL DENTISTRY PC
Entity type:Organization
Organization Name:SALEH ELAHWAL DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELAHWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-748-1122
Mailing Address - Street 1:481 83RD STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-748-1122
Mailing Address - Fax:718-748-9400
Practice Address - Street 1:481 83RD STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-748-1122
Practice Address - Fax:718-748-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042462-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01161471Medicaid