Provider Demographics
NPI:1922179217
Name:ELKHAL, STEVEN TOUFIK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:TOUFIK
Last Name:ELKHAL
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 1:4117 SW 5TH DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6427
Mailing Address - Country:US
Mailing Address - Phone:503-724-3245
Mailing Address - Fax:
Practice Address - Street 1:15925 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-3525
Practice Address - Country:US
Practice Address - Phone:503-253-0291
Practice Address - Fax:503-253-1096
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87241223E0200X
WADE602158871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics