Provider Demographics
NPI:1043790942
Name:ELHADY DENTAL 2 PLLC
Entity Type:Organization
Organization Name:ELHADY DENTAL 2 PLLC
Other - Org Name:GOSMILES GAINESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-753-3346
Mailing Address - Street 1:7462 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4007
Mailing Address - Country:US
Mailing Address - Phone:703-753-3346
Mailing Address - Fax:
Practice Address - Street 1:7462 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4007
Practice Address - Country:US
Practice Address - Phone:703-753-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410263122300000X
VA04014152721223S0112X
VA04014108211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty