Healthcare Provider Details

I. General information

NPI: 1134615628
Provider Name (Legal Business Name): CARLISLE SALCEDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 CENTER AVE STE 305
HUNTINGTON BEACH CA
92647-9119
US

IV. Provider business mailing address

7677 CENTER AVE STE 305
HUNTINGTON BEACH CA
92647-9119
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-8501
  • Fax:
Mailing address:
  • Phone: 714-847-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number102644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: