Provider Demographics
NPI:1811303274
Name:AL SALAYTA, MUHANNAD SHEBLI (DDS)
Entity type:Individual
Prefix:DR
First Name:MUHANNAD
Middle Name:SHEBLI
Last Name:AL SALAYTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 OVERLAND AVE
Mailing Address - Street 2:APT. #220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6344
Mailing Address - Country:US
Mailing Address - Phone:512-769-1776
Mailing Address - Fax:
Practice Address - Street 1:3701 OVERLAND AVE
Practice Address - Street 2:APT. #220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6344
Practice Address - Country:US
Practice Address - Phone:512-769-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist