Provider Demographics
NPI:1093430852
Name:ABUSALUM, ISLAM (DMD)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:
Last Name:ABUSALUM
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 1:2824 ROGERS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3896
Mailing Address - Country:US
Mailing Address - Phone:917-714-6985
Mailing Address - Fax:
Practice Address - Street 1:2824 ROGERS RD STE 103
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3896
Practice Address - Country:US
Practice Address - Phone:917-714-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC135021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice