Organization
M ELDER D D S A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHR FAIRUKE ELDER DDS, MD (PRESIDENT / CEO)
(415) 892-1190
Entity
Organization
Contact information
Practice address
2150 APPIAN WAY STE 201, PINOLE ORAL SURGERY, PINOLE, CA 94564-2520
(510) 724-3922
(510) 724-1037
Mailing address
140 ADMIRAL CALLAGHAN LANE STE B, VALLEJO, CA 94591
(415) 892-1190
(415) 892-7355
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
46586
CA
Other
Enumeration date
10/01/2008
Last updated
08/18/2016
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