Provider Demographics
NPI:1235324278
Name:SALEM, SULTAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SULTAN
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 1:420 LEXINGTON AVE.
Mailing Address - Street 2:228
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170
Mailing Address - Country:US
Mailing Address - Phone:212-991-0661
Mailing Address - Fax:206-984-9919
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:228
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-991-0661
Practice Address - Fax:206-984-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist