Provider Demographics
NPI:1932886652
Name:ELGABROUNY, MOHAMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ELGABROUNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 PEACHTREE ST NE APT 16G
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-4137
Mailing Address - Country:US
Mailing Address - Phone:908-720-6941
Mailing Address - Fax:
Practice Address - Street 1:1382 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4411
Practice Address - Country:US
Practice Address - Phone:678-664-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN123153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program