Elsa Dental and Orthodontics, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ELSA DENTAL AND ORTHODONTICS, PLLC

Practice address

100 E 15TH St
520
Fort Worth, TX 76102-6550

Phone

(817) 529-8151

NPI assigned

Nov 18, 2016

Organization subpart

No

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

Authorized official

Name

Raffy Kouyoumdjian

Title

Owner

Phone

(817) 529-8151

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bushra Mahmoud

  • General Practice Dentistry
  • Elsa, TX
  • NPI 1093456725
  NPD (past)

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1831632173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 EAST EDINBURG AVENUE",
            "address_2": "A",
            "city": "ELSA",
            "state": "TX",
            "postal_code": "78534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 15TH ST",
            "address_2": "520",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761026550",
            "telephone_number": "817-529-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELSA DENTAL AND ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "KOUYOUMDJIAN",
        "authorized_official_first_name": "RAFFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-8151"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182419511",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merita Elmazi, LPC
• Elizabeth Elmore, PT, DPT
• Bayoumy N. Elnady, PT,DPT
• Mennat Elnajdi, R.PH
• Hope Elofson, M.D.
• Marwa Elsaad
• Bachar Elsaadi, MD
• Alicia Marie Elsea, RN
• Kerbi Dawn Elsenbroek, PA
• Mona Eltiar, APRN, FNP

• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.