Provider Demographics
NPI:1558302646
Name:ELASAAD, MICHAEL G (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:ELASAAD
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 1:10334 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8153
Mailing Address - Country:US
Mailing Address - Phone:630-305-0312
Mailing Address - Fax:630-305-0233
Practice Address - Street 1:10334 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8153
Practice Address - Country:US
Practice Address - Phone:630-305-0312
Practice Address - Fax:630-305-0233
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics