# M ELDER D D S A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760633341
- **Authorized official:** DR. MAHR FAIRUKE ELDER DDS, MD (PRESIDENT / CEO)
- **Authorized official phone:** (415) 892-1190

## Contact information

- **Practice address:** 2150 APPIAN WAY STE 201, PINOLE ORAL SURGERY, PINOLE, CA 94564-2520
- **Practice address phone:** (510) 724-3922
- **Practice address fax:** (510) 724-1037
- **Mailing address:** 140 ADMIRAL CALLAGHAN LANE STE B, VALLEJO, CA 94591
- **Mailing address phone:** (415) 892-1190
- **Mailing address fax:** (415) 892-7355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 46586 | CA | Yes |

## Other

- **Enumeration date:** 10/01/2008
- **Last updated:** 08/18/2016