Provider Demographics
NPI:1912511916
Name:ELKENAWY, ISLAM MOHAMED HASSAN (DDS MS)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:MOHAMED HASSAN
Last Name:ELKENAWY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 EASTSIDE ST APT 7003
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3842
Mailing Address - Country:US
Mailing Address - Phone:909-374-3057
Mailing Address - Fax:
Practice Address - Street 1:5900 LYONS AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-4808
Practice Address - Country:US
Practice Address - Phone:281-501-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics