Provider Demographics
NPI:1801975594
Name:SALIB, NADER K (DDS)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:K
Last Name:SALIB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NADER
Other - Middle Name:K
Other - Last Name:SALIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 531
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-280-3130
Mailing Address - Fax:949-364-0040
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 531
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-280-3130
Practice Address - Fax:949-364-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221124OtherPTAN (PROVIDER TRANSACTION AUTHORIZATION NUMBER)