Lisa Gabrielle Salloum, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN12847 Issued in FL

Practice address

9000 Golfside Dr
Suite a
Jacksonville, FL 32256-7793

Phone

(904) 737-8410

Fax

(904) 367-1739

NPI assigned

Dec 9, 2008

Last updated

Dec 9, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 25, 2021 through Mar 25, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smilecare Dental Associates PA

  • Dentist
  • Jacksonville, FL
  • NPI 1629107537
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228780800000",
    "number": "1588809206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 GOLFSIDE DR",
            "address_2": "SUITE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567793",
            "telephone_number": "904-367-1722",
            "fax_number": "904-367-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 GOLFSIDE DR",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567793",
            "telephone_number": "904-737-8410",
            "fax_number": "904-367-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLOUM",
        "first_name": "LISA",
        "middle_name": "GABRIELLE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2008-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN12847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah E Saliba, MD
• Saima Salim, MD
• Andrew Salinas, DPT
• Latisha Salisbury, MPH
• Richard Salko, D.M.D
• Waddah Salman, MD
• Andrea Carolina Salom, DPT
• Leslie J Salomone, MD
• Matthew M Salomone, MD
• Jehser Salonga

• Periodontics in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.