Provider Demographics
NPI:1629133657
Name:SELEEM, DALIA (DDS)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:SELEEM
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 1:7551 VISTA MONTANA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9010
Mailing Address - Country:US
Mailing Address - Phone:909-238-2969
Mailing Address - Fax:909-581-1977
Practice Address - Street 1:10797 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3858
Practice Address - Country:US
Practice Address - Phone:909-581-0888
Practice Address - Fax:909-581-1977
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice