Healthcare Provider Details

I. General information

NPI: 1629326400
Provider Name (Legal Business Name): BEHNAM SALAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 MANZANITA LN
RENO NV
89509-7033
US

IV. Provider business mailing address

2585 MANZANITA LN
RENO NV
89509-7033
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-0562
  • Fax:
Mailing address:
  • Phone: 310-968-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number61687
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-120
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDB-2026-0143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: