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General NPI Number Information
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NPI Number | 1083304455
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Entity Type | Organization
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Legal Business Name | SALT DENTAL DMD LLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 4300 TALBOT RD S STE 105
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City | RENTON
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State | WA
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Zip | 98055-6238
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Country | US
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Telephone | 360-547-3687
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Fax | 206-703-2817
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Provider Business Mailing Address
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Address Line | 4300 TALBOT RD S STE 105
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City | RENTON
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State | WA
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Zip | 98055-6238
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Country | US
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Telephone | 206-395-4748
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Fax | 206-703-2817
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Authorized Official
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Title or Position | DENTIST
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Name | CAM-TU VO
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Credential | DMD
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Telephone | 360-547-3687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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