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General NPI Number Information
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NPI Number | 1104301803
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Entity Type | Organization
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Legal Business Name | SALEM DENTISTRY PC
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 823 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-4512
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Country | US
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Telephone | 562-435-8339
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Fax | 562-436-9422
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Provider Business Mailing Address
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Address Line | 823 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-4512
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Country | US
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Telephone | 562-435-8339
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Fax | 562-436-9422
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ROXANA SALEM
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Credential |
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Telephone | 562-435-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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