MEDICARE: ISLAM ABUSALUM DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13502	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093430852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISLAM ABUSALUM DMD

Provider Business Mailing Address
First Line	:	2824 ROGERS RD STE 103
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3896
Country	:	US
Telephone Number	:	917-714-6985
Fax Number	:

Provider Business Practice Location Address
First Line	:	2824 ROGERS RD STE 103
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3896
Country	:	US
Telephone Number	:	917-714-6985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	12/25/2023

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