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General NPI Number Information
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NPI Number | 1780194985
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Entity Type | Organization
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Legal Business Name | MIRHAMID SALEK, DDS, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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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 | 91791-1148
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Country | US
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Telephone | 626-966-8408
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Fax |
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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 | PRESIDENT
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Name | DR. MIRHAMID SALEK
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Credential | DDS
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Telephone | 626-644-8618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60319906
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License Number State | WA
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