Provider Demographics
NPI:1225868102
Name:HABIBI, ELAHEH (DDS)
Entity type:Individual
Prefix:
First Name:ELAHEH
Middle Name:
Last Name:HABIBI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 BURNT MILL RD APT 712
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4669
Mailing Address - Country:US
Mailing Address - Phone:904-400-8044
Mailing Address - Fax:
Practice Address - Street 1:3316 3RD ST S STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-6090
Practice Address - Country:US
Practice Address - Phone:904-853-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist