Healthcare Provider Details

I. General information

NPI: 1386744548
Provider Name (Legal Business Name): MOHAMMED SALAHUDDIN D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE SUITE 590
ROCHESTER NY
14621-3038
US

IV. Provider business mailing address

1415 PORTLAND AVE SUITE 590
ROCHESTER NY
14621-3038
US

V. Phone/Fax

Practice location:
  • Phone: 585-336-5100
  • Fax: 585-266-1861
Mailing address:
  • Phone: 585-336-5100
  • Fax: 585-266-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number040478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: