Provider Demographics
NPI:1831936780
Name:JARRAD SALOMON, KHALIL SALAM (DMD)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:SALAM
Last Name:JARRAD SALOMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 N KIMBALL AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5415
Mailing Address - Country:US
Mailing Address - Phone:404-906-9343
Mailing Address - Fax:
Practice Address - Street 1:15544 CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3602
Practice Address - Country:US
Practice Address - Phone:708-518-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0353161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice