Provider Demographics
NPI:1417035783
Name:ELRAHEB, DANY (DDS)
Entity Type:Individual
Prefix:
First Name:DANY
Middle Name:
Last Name:ELRAHEB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2640 E LEAGUE CITY PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3368
Mailing Address - Country:US
Mailing Address - Phone:281-334-5109
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3368
Practice Address - Country:US
Practice Address - Phone:281-334-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice