Provider Demographics
NPI:1396869145
Name:MOHAMMADI, SALIM (DDS)
Entity type:Individual
Prefix:DR
First Name:SALIM
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 AUGUSTA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0789
Mailing Address - Country:US
Mailing Address - Phone:207-859-9828
Mailing Address - Fax:207-859-9825
Practice Address - Street 1:342 AUGUSTA RD STE 3
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-0789
Practice Address - Country:US
Practice Address - Phone:207-859-9828
Practice Address - Fax:207-859-9825
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics