Provider Demographics
NPI:1134291685
Name:ELMIRAHEM, MANAL H (DDS)
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:H
Last Name:ELMIRAHEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 COLOMA RD
Mailing Address - Street 2:STE 17
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-635-9800
Mailing Address - Fax:916-635-9834
Practice Address - Street 1:11050 COLOMA RD
Practice Address - Street 2:STE 17
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-635-9800
Practice Address - Fax:916-635-9834
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist