Provider Demographics
NPI:1316310634
Name:ELYASSI'S GREENBELT ORAL AND FACIAL SURGERY
Entity type:Organization
Organization Name:ELYASSI'S GREENBELT ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELYASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-982-4555
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-982-4555
Mailing Address - Fax:301-982-4557
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-982-4555
Practice Address - Fax:301-982-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1447235940OtherNPI