Provider Demographics
NPI:1801354048
Name:ABOU SALEH, TAYEM (DDS, MS)
Entity type:Individual
Prefix:
First Name:TAYEM
Middle Name:
Last Name:ABOU SALEH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 S SUGAR RD APT 2208
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0199
Mailing Address - Country:US
Mailing Address - Phone:209-600-8856
Mailing Address - Fax:
Practice Address - Street 1:16789 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2349
Practice Address - Country:US
Practice Address - Phone:210-494-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics