Provider Demographics
NPI:1518410836
Name:ELAZHRI, MOHAMED A (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:ELAZHRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOXBORO BLVD APT 7202
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-3816
Mailing Address - Country:US
Mailing Address - Phone:215-454-9942
Mailing Address - Fax:
Practice Address - Street 1:88 POND ST STE 2
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2057
Practice Address - Country:US
Practice Address - Phone:781-806-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMCS000675D1223P0300X
TX321141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics