Provider Demographics
NPI:1386837136
Name:SALAMA, MERVAT R (DDS)
Entity Type:Individual
Prefix:
First Name:MERVAT
Middle Name:R
Last Name:SALAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13109 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4416
Mailing Address - Country:US
Mailing Address - Phone:310-973-2600
Mailing Address - Fax:310-973-2701
Practice Address - Street 1:13109 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4416
Practice Address - Country:US
Practice Address - Phone:310-973-2600
Practice Address - Fax:310-973-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37493-01OtherDENTICAL