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General NPI Number Information
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NPI Number | 1912405119
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Entity Type | Organization
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Legal Business Name | SYLVIA SALEM DDS,INC.
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 650 S 1ST AVE
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City | COVINA
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State | CA
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Zip | 91723-3538
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Country | US
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Telephone | 626-332-7311
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Fax | 626-332-0052
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Provider Business Mailing Address
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Address Line | 650 S FIRST AVE
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-332-7311
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Fax |
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Authorized Official
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Title or Position | FRONT OFFICE/MANAGER
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Name | MRS. NELLIE M MEMBRENO
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Credential | RDA
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Telephone | 626-332-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47170
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License Number State | CA
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