Provider Demographics
NPI:1295015014
Name:SALEH, MO Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:MO
Middle Name:Y
Last Name:SALEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17437 BOONES FERRY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-6203
Mailing Address - Country:US
Mailing Address - Phone:503-697-0884
Mailing Address - Fax:503-697-6899
Practice Address - Street 1:16455 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4367
Practice Address - Country:US
Practice Address - Phone:503-697-0884
Practice Address - Fax:503-697-6899
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice