Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 27801 | TX |
NPI | 1114284452 |
---|---|
Provider Name | Wesam Salha |
First Address | Livingston, TX 77351-8899 |
Second Address | Livingston, TX 77351-8899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 11/04/2012 |