Provider Demographics
NPI:1841833696
Name:ELHUSSEINI MOHAMED AHMED, SARA SAFEYELDIN (BDS,MS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:SAFEYELDIN
Last Name:ELHUSSEINI MOHAMED AHMED
Suffix:
Gender:F
Credentials:BDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 DOMAIN BLVD APT 3549
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-0057
Mailing Address - Country:US
Mailing Address - Phone:954-451-6571
Mailing Address - Fax:
Practice Address - Street 1:2301 BAGDAD RD STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6501
Practice Address - Country:US
Practice Address - Phone:512-337-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics