Provider Demographics
NPI:1346553559
Name:SALEKI, EHSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:SALEKI
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 1:132 E DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2123
Mailing Address - Country:US
Mailing Address - Phone:414-762-9010
Mailing Address - Fax:
Practice Address - Street 1:132 E DREXEL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2123
Practice Address - Country:US
Practice Address - Phone:414-762-9010
Practice Address - Fax:414-762-9010
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist