Individual provider Active NPI

Sameh Said Sallam, BDS,DDS

  • Dentist
  • Moreno Valley, CA
National Provider Identifier
1689921025
Registry record updated Aug 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
61610 Issued in CA
Practice address
26468 Sand Palm CT
Moreno Valley, CA 92555-2368
Phone
(951) 807-6510
NPI assigned
Aug 3, 2012
Last updated
Aug 14, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2012

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

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61610 CA Primary
Public Health Dentistry 1223D0001X 61610 CA
Endodontics 1223E0200X 61610 CA
General Practice Dentistry 1223G0001X 61610 CA
Oral and Maxillofacial Pathology Dentistry 1223P0106X 61610 CA
Pediatric Dentistry 1223P0221X 61610 CA
Periodontics 1223P0300X 61610 CA
Prosthodontics 1223P0700X 61610 CA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 61610 CA
Oral and Maxillofacial Radiology Dentistry 1223X0008X 61610 CA
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 61610 CA

Addresses

Primary practice location

26468 Sand Palm CT
Moreno Valley, CA 92555-2368

Mailing address

26468 Sand Palm CT
Moreno Valley, CA 92555-2368
Phone (951) 807-6510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
61610CAMDOral and Maxillofacial Radiology Dentist

NPI Registry JSON

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

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344902400000",
    "number": "1689921025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26468 SAND PALM CT",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925552368",
            "telephone_number": "951-807-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26468 SAND PALM CT",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925552368",
            "telephone_number": "951-807-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLAM",
        "first_name": "SAMEH",
        "middle_name": "SAID",
        "name_prefix": "Dr.",
        "credential": "BDS,DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61610",
            "primary": true
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223X0008X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "CA",
            "license": "61610",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "61610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.