Provider Demographics
NPI:1508025826
Name:KARIM ELNOKRASHY DENTAL CORPORATION
Entity Type:Organization
Organization Name:KARIM ELNOKRASHY DENTAL CORPORATION
Other - Org Name:SMILES DEPOT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:AHMAD SAMY
Authorized Official - Last Name:ELNOKRASHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-957-8828
Mailing Address - Street 1:1503 E MARCH LN
Mailing Address - Street 2:SUITE #B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5600
Mailing Address - Country:US
Mailing Address - Phone:209-957-8828
Mailing Address - Fax:209-957-8811
Practice Address - Street 1:1503 E MARCH LN
Practice Address - Street 2:SUITE #B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5600
Practice Address - Country:US
Practice Address - Phone:209-957-8828
Practice Address - Fax:209-957-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty