Provider Demographics
NPI:1689921025
Name:SALLAM, SAMEH SAID (BDS,DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:SAID
Last Name:SALLAM
Suffix:
Gender:M
Credentials:BDS,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26468 SAND PALM CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2368
Mailing Address - Country:US
Mailing Address - Phone:951-807-6510
Mailing Address - Fax:
Practice Address - Street 1:26468 SAND PALM CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2368
Practice Address - Country:US
Practice Address - Phone:951-807-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61610122300000X, 1223D0001X, 1223E0200X, 1223G0001X, 1223P0106X, 1223P0221X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0008X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics