Individual
LISA GABRIELLE SALLOUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
9000 GOLFSIDE DR, SUITE A, JACKSONVILLE, FL 32256-7793
(904) 737-8410
(904) 367-1739
Mailing address
9000 GOLFSIDE DR, SUITE B, JACKSONVILLE, FL 32256-7793
(904) 367-1722
(904) 367-1739
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN12847
FL
Other
Enumeration date
12/09/2008
Last updated
12/09/2008
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