Provider Demographics
NPI:1760900153
Name:MOUKWA, ELALI ALISHA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELALI
Middle Name:ALISHA MARIE
Last Name:MOUKWA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELALI
Other - Middle Name:ALISHA
Other - Last Name:REIBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:224 VILLAGE WALK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540
Mailing Address - Country:US
Mailing Address - Phone:919-200-0463
Mailing Address - Fax:
Practice Address - Street 1:224 VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-200-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2025-05-08
Deactivation Date:2018-06-29
Deactivation Code:
Reactivation Date:2018-07-18
Provider Licenses
StateLicense IDTaxonomies
NC115251223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program