Provider Demographics
NPI:1619689536
Name:SALEM, ESRAA FATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESRAA
Middle Name:FATHY
Last Name:SALEM
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 1:429 CLEARWATER DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3806
Mailing Address - Country:US
Mailing Address - Phone:704-493-4534
Mailing Address - Fax:
Practice Address - Street 1:429 CLEARWATER DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3806
Practice Address - Country:US
Practice Address - Phone:704-493-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131451223G0001X
CO00205454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice