Active NPI
Angel Wahib Elbardissi, DDS
- Dentist
- North Wales, PA
National Provider Identifier
1811101967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS 019992 L
- Practice address
- 210 Stump Rd
North Wales, PA 19454 - Phone
- (215) 699-9104
- Fax
- (215) 699-9432
- NPI assigned
- May 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS 019992 L | PA | Primary |
Addresses
Primary practice location
210 Stump Rd
North Wales, PA 19454
Mailing address
210 Stump Rd
North Wales, PA 19454
Phone (215) 699-9104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS 019992 L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811101967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 STUMP RD",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "19454",
"telephone_number": "215-699-9104",
"fax_number": "215-699-9432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 STUMP RD",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "19454",
"telephone_number": "215-699-9104",
"fax_number": "215-699-9432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELBARDISSI",
"first_name": "ANGEL",
"middle_name": "WAHIB",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS 019992 L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Wales, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.