MEDICARE: RYAN SALEH ATLASI DMD

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	122300000X	Dentist	D14762	MN

General Provider Information

NPI Number	:	1619607850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SALEH ATLASI DMD

Provider Business Mailing Address
First Line	:	5325 NEWCASTLE AVE UNIT 126
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4653
Country	:	US
Telephone Number	:	310-909-9471
Fax Number	:

Provider Business Practice Location Address
First Line	:	4273 W CIRCLE DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-8788
Country	:	US
Telephone Number	:	507-322-1886
Fax Number	:

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

Provider Enumeration Date	:	06/11/2022
Last Update Date	:	06/11/2022

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