Healthcare Provider Details

I. General information

NPI: 1376165852
Provider Name (Legal Business Name): NEALA SALMASSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CRAIN HWY S STE 5
GLEN BURNIE MD
21061-3657
US

IV. Provider business mailing address

1616 13TH AVE STE 200
HUNTINGTON WV
25701-3840
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-6464
  • Fax:
Mailing address:
  • Phone: 304-691-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17373
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: