Provider Demographics
NPI:1790493252
Name:RISE DENTAL
Entity Type:Organization
Organization Name:RISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-831-9656
Mailing Address - Street 1:255 SHADOW MOUNTAIN DR STE G&H
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4757
Mailing Address - Country:US
Mailing Address - Phone:915-831-9656
Mailing Address - Fax:
Practice Address - Street 1:255 SHADOW MOUNTAIN DR STE G&H
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4757
Practice Address - Country:US
Practice Address - Phone:915-831-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty