Healthcare Provider Details

I. General information

NPI: 1275017337
Provider Name (Legal Business Name): SALAR AND DELISLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT ROSE ST STE A
RENO NV
89509-3426
US

IV. Provider business mailing address

75 MOUNT ROSE ST STE A
RENO NV
89509-3426
US

V. Phone/Fax

Practice location:
  • Phone: 775-971-4252
  • Fax:
Mailing address:
  • Phone: 775-971-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BEHNAM SALAR
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 310-968-0562