Mohamed M Elghannam, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401417740 Issued in VA

Practice address

220 W Brambleton Ave Ste 111
Norfolk, VA 23510-1571

Phone

(757) 583-1536

Fax

(757) 583-3470

NPI assigned

Jul 13, 2020

Last updated

Mar 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 VA

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

Locations

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.

• Elghannam Dental LLC

  dba WOODBRIDGE FAMLIY AND IMPLANT Dentistry

  • General Practice Dentistry
  • Woodbridge, VA
  • NPI 1164234910
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646524800000",
    "number": "1831717180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W BRAMBLETON AVE STE 111",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101571",
            "telephone_number": "757-583-1536",
            "fax_number": "757-583-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W BRAMBLETON AVE STE 111",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101571",
            "telephone_number": "757-583-1536",
            "fax_number": "757-583-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELGHANNAM",
        "first_name": "MOHAMED",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2022-03-06",
        "certification_date": "2022-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohamed Elebasy
• Bushirat Adeola Elegbede
• Elevate Healthcare Services LLC
• Janel Eley
• Shirley Marie Elfishawy, MD
• Elite Harmony Home Health Care Services LLC
• Elite Women's Care
• Sandra Elizabeth, LMT
• Kate Elkins
• Kimmy Shin Eller, MS, CCC-SLP

• General Practice Dentistry in Norfolk, VA
• Providers in Norfolk, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2022; 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.