Individual
MOATAZ SALAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5540 WALNUT AVE APT 14C, DOWNERS GROVE, IL 60515-4127
(661) 916-9850
Mailing address
5836 S HARLEM AVE STE 200, SUMMIT, IL 60501-1407
(708) 215-4000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019031474
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019.031474
—
IL
Enumeration date
02/02/2018
Last updated
11/20/2019
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