Healthcare Provider Details

I. General information

NPI: 1871832097
Provider Name (Legal Business Name): RITU SALWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TEXAS ST SUITE 12
FAIRFIELD CA
94533-4462
US

IV. Provider business mailing address

1507 S. 348TH STREET SUITE K-102
FEDERAL WAY WA
98003
US

V. Phone/Fax

Practice location:
  • Phone: 707-428-5400
  • Fax:
Mailing address:
  • Phone: 253-835-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60154107
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: