Provider Demographics
NPI:1790216315
Name:DINA ELHOUT DDS PC
Entity Type:Organization
Organization Name:DINA ELHOUT DDS PC
Other - Org Name:CENTER FOR MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-563-6601
Mailing Address - Street 1:430 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1619
Mailing Address - Country:US
Mailing Address - Phone:313-563-6601
Mailing Address - Fax:313-563-6986
Practice Address - Street 1:430 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1619
Practice Address - Country:US
Practice Address - Phone:313-563-6601
Practice Address - Fax:313-563-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021238122300000X
MI29010210981223P0300X
MI29010207291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty