MEDICARE: DRS SALEM AND SOLIMAN DENTAL CORP

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1326729401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS SALEM AND SOLIMAN DENTAL CORP

Provider Business Mailing Address
First Line	:	9707 BLANSFIELD WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-4021
Country	:	US
Telephone Number	:	916-849-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 COLUSA AVE STE C
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4143
Country	:	US
Telephone Number	:	916-849-3174
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. AHMED SALEM
Credential	:
Telephone Number	:	916-849-3174

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	08/03/2023

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