Provider Demographics
NPI:1902585870
Name:ELDERBASHY, ISLAM SALEH (DMD)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:SALEH
Last Name:ELDERBASHY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SW 71ST TER APT 714
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1118
Mailing Address - Country:US
Mailing Address - Phone:734-604-7471
Mailing Address - Fax:
Practice Address - Street 1:1194 BIG BETHEL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1906
Practice Address - Country:US
Practice Address - Phone:757-239-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401418589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program