Provider Demographics
NPI:1235367350
Name:SHARAF-ELDEEN, EHSAN YAHYA (DMD, MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:YAHYA
Last Name:SHARAF-ELDEEN
Suffix:
Gender:M
Credentials:DMD, MD, FACS
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Mailing Address - Street 1:7777 N WICKHAM RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7978
Mailing Address - Country:US
Mailing Address - Phone:321-255-6303
Mailing Address - Fax:321-255-6710
Practice Address - Street 1:1500 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-253-6634
Practice Address - Fax:386-258-8775
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN184301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery