Provider Demographics
NPI:1457974198
Name:ELMEKKAWI, SHADI AHMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:AHMED
Last Name:ELMEKKAWI
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 1:10 SUMMER ST APT 403
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3927
Mailing Address - Country:US
Mailing Address - Phone:754-234-6971
Mailing Address - Fax:
Practice Address - Street 1:10 SUMMER ST APT 403
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3927
Practice Address - Country:US
Practice Address - Phone:754-234-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24903122300000X
MADN1858646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist