Provider Demographics
NPI:1841301371
Name:ELDER, MAHR F (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MAHR
Middle Name:F
Last Name:ELDER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ADMIRAL CALLAGHAN LN STE B
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4005
Mailing Address - Country:US
Mailing Address - Phone:707-552-5644
Mailing Address - Fax:707-552-5644
Practice Address - Street 1:1805 NOVATO BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2934
Practice Address - Country:US
Practice Address - Phone:415-892-1190
Practice Address - Fax:415-892-7355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465861223S0112X
MIA 937711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9179922OtherCMSP PROVIDER NUMBER
CAG9380301OtherMEDI-CAL PROVIDER ID#
CA523194OtherMEDI-CAL ID NUMBER