Provider Demographics
NPI:1154445484
Name:ELCHAHAL, ALEC N (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:N
Last Name:ELCHAHAL
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 1:4395 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6048
Mailing Address - Country:US
Mailing Address - Phone:770-622-1177
Mailing Address - Fax:770-622-2239
Practice Address - Street 1:4395 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6048
Practice Address - Country:US
Practice Address - Phone:770-622-1177
Practice Address - Fax:770-622-2239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0115811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582481876OtherTIN#