Provider Demographics
NPI:1437326188
Name:SALIH DENTAL CENTER
Entity Type:Organization
Organization Name:SALIH DENTAL CENTER
Other - Org Name:SALIH DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-733-7454
Mailing Address - Street 1:1726 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1914
Mailing Address - Country:US
Mailing Address - Phone:312-733-7454
Mailing Address - Fax:
Practice Address - Street 1:1726 W 18TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1914
Practice Address - Country:US
Practice Address - Phone:312-733-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALIH DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019019186Medicaid