Provider Demographics
NPI:1629233481
Name:SALIB, TIMOTHY SAMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SAMI
Last Name:SALIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 HARBOUR VILLAGE BLVD
Mailing Address - Street 2:APT 4202
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7282
Mailing Address - Country:US
Mailing Address - Phone:321-759-1462
Mailing Address - Fax:
Practice Address - Street 1:378 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6274
Practice Address - Country:US
Practice Address - Phone:386-672-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice