MEDICARE: SALEM DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1104301803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM DENTISTRY PC

Provider Business Mailing Address
First Line	:	823 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4512
Country	:	US
Telephone Number	:	562-435-8339
Fax Number	:	562-436-9422

Provider Business Practice Location Address
First Line	:	823 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4512
Country	:	US
Telephone Number	:	562-435-8339
Fax Number	:	562-436-9422

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ROXANA SALEM
Credential	:
Telephone Number	:	562-435-8339

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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Directions to “SALEM DENTISTRY PC ” Practice Location

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