MEDICARE: DR. MUHANAD AWNI SALEM 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	1856055	MA
2	122300000X	Dentist	0401414313	VA

General Provider Information

NPI Number	:	1962759324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUHANAD AWNI SALEM DMD

Provider Business Mailing Address
First Line	:	4867 BAXTER RD STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-499-8139
Fax Number	:	757-473-8816

Provider Business Practice Location Address
First Line	:	4867 BAXTER RD STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-499-8139
Fax Number	:

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

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	07/14/2021

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