Healthcare Provider Details

I. General information

NPI: 1942432190
Provider Name (Legal Business Name): SALIM MOHAMMAD AQIL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312
US

IV. Provider business mailing address

6540 REFLECTION DR UNIT # 1227
SAN DIEGO CA
92124-5119
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4806
  • Fax:
Mailing address:
  • Phone: 714-926-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number59874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: