Provider Demographics
NPI:1811278336
Name:ELKHECHEN, ANIS (DMD)
Entity type:Individual
Prefix:
First Name:ANIS
Middle Name:
Last Name:ELKHECHEN
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 1:18022 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-1940
Mailing Address - Country:US
Mailing Address - Phone:561-716-0338
Mailing Address - Fax:
Practice Address - Street 1:1501 PRESIDENTIAL WAY STE 15
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1852
Practice Address - Country:US
Practice Address - Phone:561-686-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 189951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice