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General NPI Number Information
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NPI Number | 1043143696
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Entity Type | Organization
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Legal Business Name | LODI KIDS DENTIST A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 740 W KETTLEMAN LN
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City | LODI
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State | CA
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Zip | 95240-6051
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Country | US
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Telephone | 209-808-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 9707 BLANSFIELD WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-4021
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Country | US
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Telephone | 916-849-3174
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AHMED SALEM
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Credential | DDS
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Telephone | 916-849-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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