Individual
OBADA ITEMAAD SALEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15124 MAJESTIC CREEK DR, SOUTH CHESTERFIELD, VA 23834-6828
(804) 691-5941
Mailing address
15124 MAJESTIC CREEK DR, SOUTH CHESTERFIELD, VA 23834-6828
(804) 691-5941
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12083
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/26/2020
Last updated
11/05/2020
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