Provider Demographics
NPI:1598978231
Name:SALAHUDDIN, MOHAMED W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:W
Last Name:SALAHUDDIN
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 1:18019 DIXIE HWY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1733
Mailing Address - Country:US
Mailing Address - Phone:708-206-1005
Mailing Address - Fax:708-206-0155
Practice Address - Street 1:18019 DIXIE HWY
Practice Address - Street 2:SUITE 1B
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1733
Practice Address - Country:US
Practice Address - Phone:708-206-1005
Practice Address - Fax:708-206-0155
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice