Healthcare Provider Details

I. General information

NPI: 1093990236
Provider Name (Legal Business Name): DAVID SALIBA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 COUNTY RD 83
CANBY CA
96015-9702
US

IV. Provider business mailing address

670 COUNTY RD 83 P.O. BOX 322
CANBY CA
96015-9702
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-4641
  • Fax: 530-233-4140
Mailing address:
  • Phone: 530-233-4641
  • Fax: 530-233-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: