Provider Demographics
NPI:1649155185
Name:SADIGOV, ELKHAN
Entity type:Individual
Prefix:
First Name:ELKHAN
Middle Name:
Last Name:SADIGOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 VFW PKWY UNIT 324
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5577
Mailing Address - Country:US
Mailing Address - Phone:832-528-5150
Mailing Address - Fax:
Practice Address - Street 1:115 NE CUTOFF STE 200
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1224
Practice Address - Country:US
Practice Address - Phone:508-595-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL100965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist