Provider Demographics
NPI:1932488749
Name:ELGAR FAMILY DENTAL P.C.
Entity Type:Organization
Organization Name:ELGAR FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOINAMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-708-7171
Mailing Address - Street 1:120 ELGAR PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5103
Mailing Address - Country:US
Mailing Address - Phone:718-708-7171
Mailing Address - Fax:718-708-7172
Practice Address - Street 1:120 ELGAR PL UNIT B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5103
Practice Address - Country:US
Practice Address - Phone:718-708-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052054261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental