Healthcare Provider Details

I. General information

NPI: 1417267063
Provider Name (Legal Business Name): FAHD ALSALLEEH B.D.S, M.S, PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH & HOLDREGE ST COLLEGE OF DENTISTRY, UNIVERSITY DENTAL ASSOCIATES
LINCOLN NE
68583
US

IV. Provider business mailing address

40TH & HOLDREGE ST COLLEGE OF DENTISTRY, UNIVERSITY DENTAL ASSOCIATES
LINCOLN NE
68583
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-8900
  • Fax: 402-472-0048
Mailing address:
  • Phone: 402-472-8900
  • Fax: 402-472-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number117
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: