Provider Demographics
NPI:1518841527
Name:EHSAN Y. SHARAF-ELDEEN DMD, MD, FACS, P.A.
Entity type:Organization
Organization Name:EHSAN Y. SHARAF-ELDEEN DMD, MD, FACS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHARAF-ELDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:352-246-3131
Mailing Address - Street 1:940 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1909
Mailing Address - Country:US
Mailing Address - Phone:352-246-3131
Mailing Address - Fax:
Practice Address - Street 1:940 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1909
Practice Address - Country:US
Practice Address - Phone:352-246-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty