Healthcare Provider Details

I. General information

NPI: 1194762583
Provider Name (Legal Business Name): SALWAN WESAM ADJAJ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20015 SW PACIFIC HWY #220
SHERWOOD OR
97140-9316
US

IV. Provider business mailing address

5155 VINE ST #616
LINCOLN NE
68504-3381
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-3838
  • Fax:
Mailing address:
  • Phone: 503-969-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD8731
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: