Healthcare Provider Details

I. General information

NPI: 1407215700
Provider Name (Legal Business Name): SALAR AND DELISLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 US HIGHWAY 95A N STE 2
FERNLEY NV
89408-4602
US

IV. Provider business mailing address

1420 HIGHWAY 95A NORTH SUITE 2
FERNLEY NV
89408-4602
US

V. Phone/Fax

Practice location:
  • Phone: 425-306-2579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNV

VIII. Authorized Official

Name: STEVEN DELISLE
Title or Position: OWNER
Credential: DDS
Phone: 425-306-2579