| Mirhamid Salek, Dds, Professional Corporation | |
|
628 N Azusa Ave West Covina CA 91791-1148 | |
| (626) 966-8408 | |
| Not Available |
| Full Name | Mirhamid Salek, Dds, Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 628 N Azusa Ave, West Covina, California |
| Authorized Official Name and Position | Mirhamid Salek (PRESIDENT) |
| Authorized Official Contact | 6266448618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirhamid Salek, Dds, Professional Corporation 1021 Calle Sonrisa Glendale CA 91208-3036 Ph: (626) 644-8618 | Mirhamid Salek, Dds, Professional Corporation 628 N Azusa Ave West Covina CA 91791-1148 Ph: (626) 966-8408 |
| NPI Number | 1780194985 |
|---|---|
| Provider Enumeration Date | 10/03/2017 |
| Last Update Date | 10/03/2017 |
| Medicare PECOS PAC ID | 6103214648 |
|---|---|
| Medicare Enrollment ID | O20211102001830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780194985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 64405 (California) | Secondary |
| 261QD0000X | Clinic/center - Dental | DE60319906 (Washington) | Primary |
| Provider Name | Mirhamid Salek |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1275969156 PECOS PAC ID: 3274854187 Enrollment ID: I20211102001877 |
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