Healthcare Provider Details

I. General information

NPI: 1376435073
Provider Name (Legal Business Name): ROOTS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 POMPTON AVE FL 1
VERONA NJ
07044-3016
US

IV. Provider business mailing address

184 POMPTON AVE FL 1
VERONA NJ
07044-3016
US

V. Phone/Fax

Practice location:
  • Phone: 973-779-3771
  • Fax:
Mailing address:
  • Phone: 973-779-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HAMED MAHMOUD SALH
Title or Position: DR
Credential: DMD
Phone: 302-824-5619