John Salek-Raham, MD DDS
Individual provider Active NPI Oral & Maxillofacial Surgery (D.M.D.) · North Oaks, MN
NPI 1154760932 · NPPES record last updated Oct 20, 2020
Key facts
- NPI
- 1154760932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.) 204E00000X
- License
- 67345 (MN)
- Practice address
- 700 Village Center Dr.
Ste 170
North Oaks, MN 55127-3025 - Phone
- (651) 482-0065
- Fax
- (651) 482-6144
- NPI assigned
- Jun 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200714002222 | MN | Practitioner - Maxillofacial Surgery | 6608170311 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S157 | MN | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gillette Children'S Specialty Healthcare | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2901021011 | MI | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | S157 | MN | |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 4301119400 | MI | |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 67345 | MN | Yes |
Addresses
Primary practice location
700 Village Center Dr.
Ste 170
North Oaks, MN 55127-3025
Mailing address
700 Village Center Dr.
Ste 170
North Oaks, MN 55127-3025
Phone (651) 482-0065
Other providers in North Oaks, MN
- Prime Chiropractic & Rehab Center
- Prime Family Medical Clinic
- Anudeep K Rahil
- Brittany Raymond
- Roger Lee Rengel
- Josephine Ann Sauro
- Serene Oaks Dental
- Patti Teachout
- The Gorman Center for Fine Den
- Beth Tracy
All providers in North Oaks, MN · Oral & Maxillofacial Surgery (D.M.D.) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.