MEDICARE: RULA A. AL-SALTI DDS.INC

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	53815	CA

General Provider Information

NPI Number	:	1639413628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RULA A. AL-SALTI DDS.INC

Provider Business Mailing Address
First Line	:	701 W VALLEY BLVD STE 76
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-3243
Country	:	US
Telephone Number	:	626-872-6301
Fax Number	:	626-320-8500

Provider Business Practice Location Address
First Line	:	701 W VALLEY BLVD STE 76
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-3243
Country	:	US
Telephone Number	:	626-872-6301
Fax Number	:	626-320-8500

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RULA A AL-SALTI
Credential	:	DDS
Telephone Number	:	626-392-1719

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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