Provider Demographics
NPI:1912567413
Name:ELHAMADY, AHMED MOUSTAFA M M (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:MOUSTAFA M M
Last Name:ELHAMADY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97101-0343
Mailing Address - Country:US
Mailing Address - Phone:971-267-7169
Mailing Address - Fax:
Practice Address - Street 1:5542 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1200
Practice Address - Country:US
Practice Address - Phone:414-464-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002086-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist