Individual
DR. MAHR F ELDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
1805 NOVATO BLVD, SUITE #1, NOVATO, CA 94947-2934
(415) 892-1190
(415) 892-7355
Mailing address
140 ADMIRAL CALLAGHAN LN STE B, VALLEJO, CA 94591-4005
(707) 552-5644
(707) 552-5644
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
46586
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
523194
MEDI-CAL ID NUMBER
CA
01
—
9179922
CMSP PROVIDER NUMBER
CA
01
—
G9380301
MEDI-CAL PROVIDER ID#
CA
Enumeration date
08/31/2006
Last updated
03/06/2025
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