Provider Demographics
NPI:1316396401
Name:ELFAR, MINA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:A
Last Name:ELFAR
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 1:2800 RACHEL TER
Mailing Address - Street 2:APT 13
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9674
Mailing Address - Country:US
Mailing Address - Phone:201-921-4667
Mailing Address - Fax:
Practice Address - Street 1:167 GROVE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3027
Practice Address - Country:US
Practice Address - Phone:973-458-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026406001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice