Provider Demographics
NPI:1457965238
Name:SHALOM DENTAL
Entity Type:Organization
Organization Name:SHALOM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:OLAYINKA
Authorized Official - Last Name:GBENLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-254-1193
Mailing Address - Street 1:5801 ALLENTOWN RD STE 307
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4582
Mailing Address - Country:US
Mailing Address - Phone:240-455-7842
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD STE 307
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4582
Practice Address - Country:US
Practice Address - Phone:240-455-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty