Healthcare Provider Details

I. General information

NPI: 1346890977
Provider Name (Legal Business Name): DENTAL GROUP OF SALEEM AND ALFROUKH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N I ST
MADERA CA
93637-4408
US

IV. Provider business mailing address

121 N I ST
MADERA CA
93637-4408
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD SALEEM
Title or Position: PRESIDENT
Credential:
Phone: 646-387-2465