MEDICARE: DR. MOHAMMAD SALAD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D12779	MN

General Provider Information

NPI Number	:	1033438858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD SALAD DDS

Provider Business Mailing Address
First Line	:	4111 CENTRAL AVE NE
Second Line	:	SUITE 104
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2953
Country	:	US
Telephone Number	:	763-400-3525
Fax Number	:	763-244-1217

Provider Business Practice Location Address
First Line	:	4111 CENTRAL AVE NE
Second Line	:	SUITE 104
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2953
Country	:	US
Telephone Number	:	763-400-3525
Fax Number	:	763-244-1217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	04/07/2012

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