Provider Demographics
NPI:1689397655
Name:SALAM DENTAL PC
Entity Type:Organization
Organization Name:SALAM DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELSALAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-447-9212
Mailing Address - Street 1:111 W WACKER DR APT 4505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1691
Mailing Address - Country:US
Mailing Address - Phone:347-447-9212
Mailing Address - Fax:
Practice Address - Street 1:8441 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2953
Practice Address - Country:US
Practice Address - Phone:847-589-1400
Practice Address - Fax:855-599-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental