Provider Demographics
NPI:1124354279
Name:SALAMA & ALKHALAYLEH DENTAL CORP
Entity type:Organization
Organization Name:SALAMA & ALKHALAYLEH DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASFI
Authorized Official - Middle Name:FOUAD
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-366-6527
Mailing Address - Street 1:201 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1707
Mailing Address - Country:US
Mailing Address - Phone:661-393-4333
Mailing Address - Fax:661-393-4343
Practice Address - Street 1:201 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1707
Practice Address - Country:US
Practice Address - Phone:661-393-4333
Practice Address - Fax:661-393-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALAMA & ALKHALAYLEH DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40854122300000X
CA535131223E0200X
CA524641223G0001X
CA500711223S0112X
CA552211223S0112X
CA539171223S0112X
CA478361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94115-02Medicaid