Provider Demographics
NPI:1801335989
Name:ANTHONY A. ELGOHARY, DMD, PLLC
Entity type:Organization
Organization Name:ANTHONY A. ELGOHARY, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-484-4197
Mailing Address - Street 1:5131 RIVER CLUB DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3661
Mailing Address - Country:US
Mailing Address - Phone:757-484-4197
Mailing Address - Fax:757-483-9065
Practice Address - Street 1:5131 RIVER CLUB DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3661
Practice Address - Country:US
Practice Address - Phone:757-484-4197
Practice Address - Fax:757-483-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014108241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty