Provider Demographics
NPI:1134002454
Name:HUSSEIN, ELZAHRAA NASSER TELEB (DMD)
Entity type:Individual
Prefix:
First Name:ELZAHRAA
Middle Name:NASSER TELEB
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 TURTLE CREEK DR APT 5
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1565
Mailing Address - Country:US
Mailing Address - Phone:913-617-5073
Mailing Address - Fax:
Practice Address - Street 1:580 BROAD ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1420
Practice Address - Country:US
Practice Address - Phone:262-248-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001933-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice