Provider Demographics
NPI:1053440115
Name:SALAMA & AL-KHALAYLEH DENTAL CORPORATION
Entity type:Organization
Organization Name:SALAMA & AL-KHALAYLEH DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASFI
Authorized Official - Middle Name:FOUAD
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-366-6527
Mailing Address - Street 1:5917 NILES ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4695
Mailing Address - Country:US
Mailing Address - Phone:661-366-6527
Mailing Address - Fax:661-366-5400
Practice Address - Street 1:5917 NILES ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4695
Practice Address - Country:US
Practice Address - Phone:661-366-6527
Practice Address - Fax:661-366-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478361223G0001X
CA524641223G0001X
CA223871223G0001X
CA452621223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94115-01Medicaid