Provider Demographics
NPI:1679797526
Name:ELFAHAL, MANAL MAHDI (DMD)
Entity type:Individual
Prefix:DR
First Name:MANAL
Middle Name:MAHDI
Last Name:ELFAHAL
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:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:SUNCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03275-0165
Mailing Address - Country:US
Mailing Address - Phone:603-485-8464
Mailing Address - Fax:
Practice Address - Street 1:50 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275-2366
Practice Address - Country:US
Practice Address - Phone:603-485-8464
Practice Address - Fax:603-485-4884
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30304170Medicaid