Provider Demographics
NPI:1396096574
Name:ELCHEKHA, HOUSSAM (DDS)
Entity type:Individual
Prefix:
First Name:HOUSSAM
Middle Name:
Last Name:ELCHEKHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2476
Mailing Address - Country:US
Mailing Address - Phone:414-306-6420
Mailing Address - Fax:877-335-3684
Practice Address - Street 1:4915 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4221
Practice Address - Country:US
Practice Address - Phone:414-306-6420
Practice Address - Fax:877-335-3684
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7001-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice