Provider Demographics
NPI:1790467785
Name:ELEVATE DENTAL
Entity Type:Organization
Organization Name:ELEVATE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-824-3531
Mailing Address - Street 1:1347 BURNING ARROW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2765
Mailing Address - Country:US
Mailing Address - Phone:617-319-1050
Mailing Address - Fax:
Practice Address - Street 1:2311 HARRY WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5543
Practice Address - Country:US
Practice Address - Phone:210-824-3531
Practice Address - Fax:210-824-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty