Provider Demographics
NPI:1285106716
Name:DENTASPA PLLC
Entity type:Organization
Organization Name:DENTASPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-471-3670
Mailing Address - Street 1:2960 INTERSTATE 45 N STE 300
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-7912
Mailing Address - Country:US
Mailing Address - Phone:909-471-3670
Mailing Address - Fax:210-447-7088
Practice Address - Street 1:2960 INTERSTATE 45 N STE 300
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-7912
Practice Address - Country:US
Practice Address - Phone:909-471-3670
Practice Address - Fax:210-447-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty