Provider Demographics
NPI:1609081686
Name:SALOUM, FADI S (DDS)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:S
Last Name:SALOUM
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 1:135 N SHORTRIDGE RD STE B3
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-8905
Mailing Address - Country:US
Mailing Address - Phone:317-357-3636
Mailing Address - Fax:317-357-3778
Practice Address - Street 1:135 N SHORTRIDGE RD STE B3
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-8905
Practice Address - Country:US
Practice Address - Phone:317-357-3636
Practice Address - Fax:317-357-3778
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics