Provider Demographics
NPI:1891959045
Name:ELZAYAT, FADI EDMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:EDMOND
Last Name:ELZAYAT
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 1:11335 MAGNOLIA BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4950
Mailing Address - Country:US
Mailing Address - Phone:818-755-1588
Mailing Address - Fax:818-755-1838
Practice Address - Street 1:11335 MAGNOLIA BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4950
Practice Address - Country:US
Practice Address - Phone:818-755-1588
Practice Address - Fax:818-755-1838
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist