Provider Demographics
NPI:1114652286
Name:MANASSAS MODERN DENTISTRY PLLC
Entity Type:Organization
Organization Name:MANASSAS MODERN DENTISTRY PLLC
Other - Org Name:MANASSAS MODERN DENTISTRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-827-1164
Mailing Address - Street 1:10620 CRESTWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4403
Mailing Address - Country:US
Mailing Address - Phone:703-361-2911
Mailing Address - Fax:
Practice Address - Street 1:10620 CRESTWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4403
Practice Address - Country:US
Practice Address - Phone:703-361-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty