Healthcare Provider Details

I. General information

NPI: 1417743089
Provider Name (Legal Business Name): HARRIS ASHARI SALOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 JAMESTOWN RD
WILLIAMSBURG VA
23185-3365
US

IV. Provider business mailing address

713 KNOB HILL DR
BLACKSBURG VA
24060-5080
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0400
  • Fax:
Mailing address:
  • Phone: 540-449-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14225396-9926
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: