Healthcare Provider Details

I. General information

NPI: 1003669730
Provider Name (Legal Business Name): SARAH ALENA SALCEDO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11437 OLIVE BLVD
SAINT LOUIS MO
63141-7108
US

IV. Provider business mailing address

2305 SILVERNAIL RD
PEWAUKEE WI
53072-5402
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001766-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: