=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588058598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.SALAMEH AND PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2015
-----------------------------------------------------
Last Update Date | 03/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9519 STATE ROUTE 14
-----------------------------------------------------
City | STREETSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44241-5227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-715-0265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12500 EDGEWATER DR APT 1004
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-715-0265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OMAR SALAMEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-715-0265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 30.023312
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------