Provider Demographics
NPI:1770737488
Name:ELMAHDI, ABDELNASER MUSTAFA (BDS DDS)
Entity type:Individual
Prefix:DR
First Name:ABDELNASER
Middle Name:MUSTAFA
Last Name:ELMAHDI
Suffix:
Gender:M
Credentials:BDS DDS
Other - Prefix:
Other - First Name:ABDELNASER
Other - Middle Name:MUSTAFA
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1944 BRASELTON HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3033
Mailing Address - Country:US
Mailing Address - Phone:770-696-9450
Mailing Address - Fax:
Practice Address - Street 1:1944 BRASELTON HWY STE 107
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3033
Practice Address - Country:US
Practice Address - Phone:770-696-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020810122300000X
TX27542122300000X
MI2109642122300000X
GARESIDENT AT MCG1223P0700X
GADN0148931223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist