Elnazer DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ELNAZER DMD

Practice address

2900 Main St Ste 2C
Stratford, CT 06614-4946

Phone

(203) 375-1649

Fax

(203) 377-5251

NPI assigned

Aug 8, 2023

Organization subpart

No

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

Authorized official

Name

Mohamed Elnazer, DMD

Title

Dentist

Phone

(203) 375-1649

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dentistry of Connecticut Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1902589922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 MAIN ST STE 2C",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144946",
            "telephone_number": "203-375-1649",
            "fax_number": "203-377-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 MAIN ST STE 2C",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144946",
            "telephone_number": "203-375-1649",
            "fax_number": "203-377-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELNAZER DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "ELNAZER",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "203-375-1649",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dentistry of Connecticut",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Dentistry of Connecticut",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Stratford, CT
• Providers in Stratford, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.