Provider Demographics
NPI:1396800173
Name:ELSHERIF, ISMAIL IBRAHIM (DDS)
Entity type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:IBRAHIM
Last Name:ELSHERIF
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 1:4550 N LARK ELLEN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3147
Mailing Address - Country:US
Mailing Address - Phone:626-331-8041
Mailing Address - Fax:626-331-4082
Practice Address - Street 1:4550 N LARK ELLEN AVE STE 104
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3147
Practice Address - Country:US
Practice Address - Phone:626-331-8041
Practice Address - Fax:626-331-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478831223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice