Provider Demographics
NPI:1528251246
Name:SHARAF -ELDEEN, ELHAM YAHYA (DMD)
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:YAHYA
Last Name:SHARAF -ELDEEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W HARRIS AVE
Mailing Address - Street 2:2A
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2496
Mailing Address - Country:US
Mailing Address - Phone:708-482-0702
Mailing Address - Fax:
Practice Address - Street 1:1 W HARRIS AVE
Practice Address - Street 2:2A
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2496
Practice Address - Country:US
Practice Address - Phone:708-482-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0280651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice