Healthcare Provider Details

I. General information

NPI: 1407438856
Provider Name (Legal Business Name): SYDNEY CULLOP SALOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY NICOLE CULLOP

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINCHESTER AVE STE 420
ASHLAND KY
41101-7367
US

IV. Provider business mailing address

4010 GRANDVIEW DR
ASHLAND KY
41101-6259
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0800
  • Fax:
Mailing address:
  • Phone: 606-547-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10588
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4532
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: