Provider Demographics
NPI:1194369942
Name:M.S. SALEK DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:M.S. SALEK DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-297-6240
Mailing Address - Street 1:300 MILITARY W STE 304
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3037
Mailing Address - Country:US
Mailing Address - Phone:707-297-6240
Mailing Address - Fax:
Practice Address - Street 1:2448 GUERNEVILLE RD STE 1000
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7226
Practice Address - Country:US
Practice Address - Phone:408-781-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty