Provider Demographics
NPI:1114094406
Name:SALEM, AHMED (DDS)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:SALEM
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 1:9707 BLANSFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4021
Mailing Address - Country:US
Mailing Address - Phone:916-849-3174
Mailing Address - Fax:
Practice Address - Street 1:9045 BRUCEVILLE RD STE 160
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5902
Practice Address - Country:US
Practice Address - Phone:916-849-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice