Healthcare Provider Details

I. General information

NPI: 1205716057
Provider Name (Legal Business Name): SALEM DENTAL-MT GILEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 MEADOW DR
MOUNT GILEAD OH
43338-1069
US

IV. Provider business mailing address

889 MEADOW DR
MOUNT GILEAD OH
43338-1069
US

V. Phone/Fax

Practice location:
  • Phone: 419-947-9547
  • Fax:
Mailing address:
  • Phone: 419-947-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALA-EL-DEAN SAMI SALEM
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 440-319-9024