Provider Demographics
NPI:1669769865
Name:JREISSATY, SALIM CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:SALIM
Middle Name:CHRISTOPHER
Last Name:JREISSATY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:CHRISTOPHER
Other - Last Name:JREISSATY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2201 WISCONSIN AVE,NW
Mailing Address - Street 2:#519
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4116
Mailing Address - Country:US
Mailing Address - Phone:202-714-1263
Mailing Address - Fax:
Practice Address - Street 1:2506 VIRGINIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1901
Practice Address - Country:US
Practice Address - Phone:202-965-5400
Practice Address - Fax:202-298-7760
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10009331223G0001X
MD146921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice