Provider Demographics
NPI:1417267063
Name:ALSALLEEH, FAHD (BDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:FAHD
Middle Name:
Last Name:ALSALLEEH
Suffix:
Gender:M
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40TH & HOLDREGE ST
Mailing Address - Street 2:COLLEGE OF DENTISTRY, UNIVERSITY DENTAL ASSOCIATES
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583
Mailing Address - Country:US
Mailing Address - Phone:402-472-8900
Mailing Address - Fax:402-472-0048
Practice Address - Street 1:40TH & HOLDREGE ST
Practice Address - Street 2:COLLEGE OF DENTISTRY, UNIVERSITY DENTAL ASSOCIATES
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:402-472-0048
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
470789985OtherUNIVERSITY DENTAL ASSOCIATES