Provider Demographics
NPI:1164503819
Name:SALEH, ANTOINE (DDS)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:SALEH
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 1:711 D ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3703
Mailing Address - Country:US
Mailing Address - Phone:415-721-0653
Mailing Address - Fax:415-721-7801
Practice Address - Street 1:711 D ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3703
Practice Address - Country:US
Practice Address - Phone:415-721-0653
Practice Address - Fax:415-721-7801
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice