Provider Demographics
NPI:1033438858
Name:SALAD, MOHAMMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:SALAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2953
Mailing Address - Country:US
Mailing Address - Phone:763-400-3525
Mailing Address - Fax:763-244-1217
Practice Address - Street 1:4111 CENTRAL AVE NE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2953
Practice Address - Country:US
Practice Address - Phone:763-400-3525
Practice Address - Fax:763-244-1217
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice