Provider Demographics
NPI:1093075970
Name:SALAMA AND ALKHALAYLEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SALAMA AND ALKHALAYLEH DENTAL CORPORATION
Other - Org Name:CENTENNIAL DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASFI
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-393-4333
Mailing Address - Street 1:201 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1707
Mailing Address - Country:US
Mailing Address - Phone:661-393-4333
Mailing Address - Fax:661-393-4343
Practice Address - Street 1:201 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1707
Practice Address - Country:US
Practice Address - Phone:661-393-4333
Practice Address - Fax:661-393-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94115-02Medicaid