Mohammed Alabdoulsalam, DDS
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Phoenix, AZ
NPI 1386486900 · NPPES record last updated Jun 14, 2025
Key facts
- NPI
- 1386486900
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1441 N 12TH St FL 3
Phoenix, AZ 85006-2837 - Phone
- (602) 521-5977
- NPI assigned
- Jun 12, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20240708000641 | AZ | Order and Referring Only - Maxillofacial Surgery |
3072057637 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | ZZ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | PENDING | ZZ | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1441 N 12TH St FL 3
Phoenix, AZ 85006-2837
Mailing address
6140 Young Street
Apt 1203
Halifax, NOVA SCOTIA B3K0G2
CM
Other practice location 1
50 Gary Martin Dr
#240
Halifax, Nova Scotia B4B 0P9
CA
Phone (902) 431-7999
Other providers in Phoenix, AZ
- Tariq Subhi Al-Mutawa
- Mohanad Turki Ali Al-Qaisi
- Heba Mazin Al-Sahlani
- Ali Shaheen Al-Yaqoobi
- Ala Hospice Care, Inc.
- Alaadin Alabeid
- Omer Alabeid
- Mohamad H Alaeddine
- Greg Alaestante
- Matthew Alafa
All providers in Phoenix, AZ · Student in an Organized Health Care Education/Training Program in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2025. 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.