Healthcare Provider Details

I. General information

NPI: 1104323971
Provider Name (Legal Business Name): NIDAL SALAMEH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 85TH ST APT 1A
BROOKLYN NY
11214-3351
US

IV. Provider business mailing address

2200 85TH ST APT 1A
BROOKLYN NY
11214-3351
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-1165
  • Fax: 347-521-2363
Mailing address:
  • Phone: 718-236-1165
  • Fax: 347-521-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number058508
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NIDAL ZAHI SALAMEH
Title or Position: DENTIST
Credential: DDS
Phone: 718-236-1165