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LISA GABRIELLE SALLOUM D.D.S.
NPI 1588809206
Dentist - Periodontics in Jacksonville, FL

Active since December 09, 2008Opted out of Medicare · through Mar 25, 2027
9000 GOLFSIDE DR, SUITE A, JACKSONVILLE, FL 32256(904) 737-8410(904) 367-1739 Get Directions Write a Review

NPPES record last updated: December 9, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lisa Gabrielle Salloum D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISA GABRIELLE SALLOUM D.D.S. (NPI 1588809206) is an individual periodontics provider in Jacksonville, Florida, licensed in Florida (DN12847) and active in the NPI registry since December 2008. She has opted out of Medicare through March 25, 2027.

NPPES Registry Identity

NPI1588809206
Entity TypeIndividualFemale
Primary Taxonomy1223P0300X
Provider Legal NameLISA GABRIELLE SALLOUMCredential: D.D.S.
Location Address9000 GOLFSIDE DR, SUITE AJacksonville, FL 32256-7793
Mailing Address9000 Golfside Dr, Suite BJacksonville, FL 32256-7793 · (904) 367-1722 · Fax (904) 367-1739
Phone(904) 737-8410
Fax(904) 367-1739
Sole ProprietorNo
Enumeration DateDecember 9, 2008
✔ NPI 1588809206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in FL · DN12847
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
9000 GOLFSIDE DR, Jacksonville, FL 32256
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Lisa Gabrielle Salloum D.d.s. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 25, 2021 through March 25, 2027.

Opt-Out Effective DateMarch 25, 2021
Opt-Out In Effect ThroughMarch 25, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELANIE WOODWARD DELOACH D.M.D
Dentist
9000 GOLFSIDE DR, SUITE B
JACKSONVILLE, FL 32256
Duval County (904) 367-1722
MRS. TATYANA I. STEPANCHUK D.M.D.
Dentist (General Practice)
9000 GOLFSIDE DR, SUITE B
JACKSONVILLE, FL 32256
Duval County (904) 367-1722

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lisa Salloum's NPI number?

The NPI number for Lisa Salloum is 1588809206. It was assigned to this individual provider in the NPPES registry on December 9, 2008.

Where is Lisa Salloum located?

Lisa Salloum practices at 9000 Golfside Dr Suite A, Jacksonville, FL 32256. The listed phone number is (904) 737-8410.

What is Lisa Salloum's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Lisa Salloum enrolled in Medicare?

No. Lisa Salloum has opted out of Medicare through March 25, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Lisa Salloum accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 11 other insurers list Lisa Salloum as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lisa Salloum was last updated on December 9, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.