Provider Demographics
NPI:1366002933
Name:ELKHAZIN, MOHAMED (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ELKHAZIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:
Other - Last Name:ELKHAZIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11348 N BLUE SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-8846
Mailing Address - Country:US
Mailing Address - Phone:424-324-4102
Mailing Address - Fax:
Practice Address - Street 1:11348 N BLUE SAGE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-8846
Practice Address - Country:US
Practice Address - Phone:424-324-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist