Provider Demographics
NPI:1114086733
Name:ELMIMEH, HANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:
Last Name:ELMIMEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 RED LION ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:267-265-1751
Mailing Address - Fax:484-383-0796
Practice Address - Street 1:5810 GREENE ST STE 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2761
Practice Address - Country:US
Practice Address - Phone:215-438-1100
Practice Address - Fax:484-383-0796
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0364041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101330854Medicaid
PA101330854Medicare ID - Type Unspecified