Provider Demographics
NPI:1164106431
Name:ELKHODARY, SARAH (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ELKHODARY
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 1:1641 WIMBERLY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6667
Mailing Address - Country:US
Mailing Address - Phone:832-561-1194
Mailing Address - Fax:
Practice Address - Street 1:1025 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3945
Practice Address - Country:US
Practice Address - Phone:713-766-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty