Provider Demographics
NPI:1508033473
Name:SALIH DENTAL OFFICE
Entity type:Organization
Organization Name:SALIH DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-286-6676
Mailing Address - Street 1:4408 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2511
Mailing Address - Country:US
Mailing Address - Phone:773-286-6676
Mailing Address - Fax:
Practice Address - Street 1:4408 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2511
Practice Address - Country:US
Practice Address - Phone:773-286-6676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALIH DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-019186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicare PIN