Provider Demographics
NPI:1861860488
Name:GILBERT DENTAL PROFESSIONALS
Entity Type:Organization
Organization Name:GILBERT DENTAL PROFESSIONALS
Other - Org Name:SMILE CLINIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-582-4411
Mailing Address - Street 1:110 S VAL VISTA DR
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1373
Mailing Address - Country:US
Mailing Address - Phone:480-892-0481
Mailing Address - Fax:
Practice Address - Street 1:110 S VAL VISTA DR
Practice Address - Street 2:SUITE B-7
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1373
Practice Address - Country:US
Practice Address - Phone:480-892-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty