=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669656625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALMAN DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 927 ARMORY RD
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-5460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-252-4488
-----------------------------------------------------
Fax | 760-252-7700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 927 ARMORY RD
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-5460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-252-4488
-----------------------------------------------------
Fax | 760-252-7700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASAD HANI SALMAN
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 760-252-4488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 48673
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------