Healthcare Provider Details

I. General information

NPI: 1023335981
Provider Name (Legal Business Name): PAULENE KATHERINE SALTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY STE 135A
IRVINE CA
92604-4766
US

IV. Provider business mailing address

5 ROCKY GLN
IRVINE CA
92603-3422
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-1300
  • Fax:
Mailing address:
  • Phone: 949-300-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number39881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: