Provider Demographics
NPI:1205424108
Name:ELKOMARY, INGY
Entity type:Individual
Prefix:
First Name:INGY
Middle Name:
Last Name:ELKOMARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 DU RHU DR APT 1305
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1269
Mailing Address - Country:US
Mailing Address - Phone:133-078-6528
Mailing Address - Fax:
Practice Address - Street 1:7765 AIRPORT BLVD STE D200
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5059
Practice Address - Country:US
Practice Address - Phone:251-214-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006837-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice