Provider Demographics
NPI:1639496318
Name:ELMAKI, TELAL A (DDS)
Entity Type:Individual
Prefix:
First Name:TELAL
Middle Name:A
Last Name:ELMAKI
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 1:21130 VICTORY BLVD APT A206
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:323-975-2121
Mailing Address - Fax:
Practice Address - Street 1:6300 WHITE LN STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-827-1100
Practice Address - Fax:661-827-1117
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice