Provider Demographics
NPI:1134565963
Name:ELTEJAYE, AHMAD (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:ELTEJAYE
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 OGLETOWN STANTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4187
Mailing Address - Country:US
Mailing Address - Phone:302-292-1600
Mailing Address - Fax:
Practice Address - Street 1:4133 OGLETOWN STANTON RD STE 200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4187
Practice Address - Country:US
Practice Address - Phone:302-292-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00115301223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery