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General NPI Number Information
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NPI Number | 1053054304
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Entity Type | Individual
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Provider Name | DEAYA SALEH DMD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 2215 OAK PARK AVE
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City | BERWYN
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State | IL
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Zip | 60402-2220
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Country | US
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Telephone | 708-218-9642
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Fax |
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Provider Business Mailing Address
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Address Line | 7042 BREMENTOWNE RD
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City | TINLEY PARK
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State | IL
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Zip | 60477-1639
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Country | US
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Telephone | 708-691-2723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033645
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License Number State | IL
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