Provider Demographics
NPI:1154313393
Name:SALAMA, SAFWAT H (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAFWAT
Middle Name:H
Last Name:SALAMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:
Other - Last Name:SALAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1701 MACOMBS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7047
Mailing Address - Country:US
Mailing Address - Phone:718-299-8144
Mailing Address - Fax:845-639-1522
Practice Address - Street 1:1701 MACOMBS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7047
Practice Address - Country:US
Practice Address - Phone:718-299-8144
Practice Address - Fax:845-639-1522
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAS8467881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
111598OtherAETNA USA PROVIDER NUMBER
NY212984OtherCIGNA DENTAL PROVIDER NUM
NY00333142Medicaid
NY212984OtherCIGNA DENTAL PROVIDER NUM