Provider Demographics
NPI:1437897501
Name:ELGENDI DDS CORPORATION
Entity Type:Organization
Organization Name:ELGENDI DDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:HAMZA
Authorized Official - Last Name:ELGENDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-582-0200
Mailing Address - Street 1:1161 HIDDEN VALLEY PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3917
Mailing Address - Country:US
Mailing Address - Phone:951-582-0200
Mailing Address - Fax:
Practice Address - Street 1:1161 HIDDEN VALLEY PKWY STE 106
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3917
Practice Address - Country:US
Practice Address - Phone:951-582-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental