Provider Demographics
NPI:1063630739
Name:ISMAIL ELSHERIF DDS A PROF CORP
Entity Type:Organization
Organization Name:ISMAIL ELSHERIF DDS A PROF CORP
Other - Org Name:PEARL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:ELSHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-617-8079
Mailing Address - Street 1:4980 BARRANCA PKWY
Mailing Address - Street 2:#203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8653
Mailing Address - Country:US
Mailing Address - Phone:949-551-5805
Mailing Address - Fax:949-551-5835
Practice Address - Street 1:4980 BARRANCA PKWY
Practice Address - Street 2:#203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8653
Practice Address - Country:US
Practice Address - Phone:949-551-5805
Practice Address - Fax:949-551-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty