Provider Demographics
NPI:1386096907
Name:AL-KHARSA, SALEH SAAD (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:SALEH
Middle Name:SAAD
Last Name:AL-KHARSA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E WACKER DR APT 1811
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5284
Mailing Address - Country:US
Mailing Address - Phone:857-756-8666
Mailing Address - Fax:
Practice Address - Street 1:504 WAVERLY DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4082
Practice Address - Country:US
Practice Address - Phone:847-214-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030641122300000X
IL021.0027601223X0400X
CT2.0112491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist