Provider Demographics
NPI:1285169573
Name:MULLA, SALAH (DDS)
Entity type:Individual
Prefix:DR
First Name:SALAH
Middle Name:
Last Name:MULLA
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 1:305 W 12TH AVENUE
Mailing Address - Street 2:THE OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE, THE OHIO STATE UNIVERSITY
Practice Address - Street 2:COLLEGE OF DENTISTRY, 4133 POSTLE HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-1421
Practice Address - Fax:614-688-5470
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-12-18
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program