Provider Demographics
NPI:1942934344
Name:ALSALLAMI, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ALSALLAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N 36TH ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3816
Mailing Address - Country:US
Mailing Address - Phone:414-454-9844
Mailing Address - Fax:414-454-9812
Practice Address - Street 1:613 N 36TH ST UNIT 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3816
Practice Address - Country:US
Practice Address - Phone:414-454-9844
Practice Address - Fax:414-454-9812
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001024-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist