Healthcare Provider Details

I. General information

NPI: 1386890598
Provider Name (Legal Business Name): NICHOLAS GEORGE SALAITA DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 W AVENUE J SUITE #3
LANCASTER CA
93534-2819
US

IV. Provider business mailing address

1523 W AVENUE J SUITE #3
LANCASTER CA
93534-2819
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-4353
  • Fax: 661-940-6064
Mailing address:
  • Phone: 661-942-4353
  • Fax: 661-940-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: