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General NPI Number Information
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NPI Number | 1427552066
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Entity Type | Organization
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Legal Business Name | SALAR AND DELISLE LLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 5055 SUN VALLEY BLVD STE 350
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City | SUN VALLEY
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State | NV
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Zip | 89433-8297
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Country | US
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Telephone | 310-968-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 5055 SUN VALLEY BLVD STE 350
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City | SUN VALLEY
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State | NV
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Zip | 89433-8297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BEN SALAR
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Credential | DMD
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Telephone | 310-968-0562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-120
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License Number State | NV
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