Provider Demographics
NPI:1811218175
Name:ELZAYAT DENTAL CORPORATION
Entity Type:Organization
Organization Name:ELZAYAT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:ELZAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-755-1588
Mailing Address - Street 1:11335 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE # 1A
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11335 MAGNOLIA BLVD
Practice Address - Street 2:SUITE # 1A
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4949
Practice Address - Country:US
Practice Address - Phone:818-755-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty