Mark Elkedwani, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109012 Issued in CA

Practice address

9510 Hageman Rd Ste B
Bakersfield, CA 93312-3953

Phone

(661) 829-2700

NPI assigned

Jun 12, 2023

Last updated

Dec 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elkedwani Dental Corporation

  dba Legacy Dental of Riverside

  • General Practice Dentistry
  • Riverside, CA
  • NPI 1720919566
  NPD Authorized official
• Huynh and Watanabe Dental Corporation

  dba River Lakes Dental Group

  • General Practice Dentistry
  • Bakersfield, CA
  • NPI 1225137573
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1356025175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 SCENIC RIVER LN APT 9N",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933087518",
            "telephone_number": "714-600-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 HAGEMAN RD STE B",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933123953",
            "telephone_number": "661-829-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKEDWANI",
        "first_name": "MARK",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Swida Skillen, DC, a Chiropractic Corp. (Neck and Back Center)
• Adrian Marcelo Elizondo Hinojosa
• Merrisa Salazar Elizondo, ASW
• Ramona Elizondo, LMFT
• Ibrahim Elkalla
• Jay Ammon Ellefson, CRNA
• Linda Ellett
• Macy Neil Ellington, CADC II
• Bethany Elliott, PNP-AC
• Cyrus Elliott

• General Practice Dentistry in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.