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General NPI Number Information
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NPI Number | 1275969156
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Entity Type | Individual
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Provider Name | MIRHAMID SALEK DDS
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Gender | Male
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 628 N AZUSA AVE
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City | WEST COVINA
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State | CA
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Zip | 91791
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Country | US
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Telephone | 626-966-8408
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Fax | 626-608-5670
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Provider Business Mailing Address
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Address Line | 1021 CALLE SONRISA
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City | GLENDALE
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State | CA
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Zip | 91208-3036
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Country | US
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Telephone | 626-644-8618
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 64405
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60319906
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License Number State | WA
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