Provider Demographics
NPI:1386744548
Name:SALAHUDDIN, MOHAMMED (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:SALAHUDDIN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 590
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-336-5100
Mailing Address - Fax:585-266-1861
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 590
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-336-5100
Practice Address - Fax:585-266-1861
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0404781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01011572Medicaid
NY70002MSOtherBLUE CROSS BLUE SHIELD ME
NY100417ATOtherPREFERRED CARE
NY100417ATOtherPREFERRED CARE
NY10495BMedicare ID - Type Unspecified