MEDICARE: DR. ALFRED RICHARD SALCIDO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-21057	CA

General Provider Information

NPI Number	:	1043375637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED RICHARD SALCIDO DDS

Provider Business Mailing Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 202
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-968-8573
Fax Number	:	626-330-4617

Provider Business Practice Location Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 202
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-968-8573
Fax Number	:	626-330-4617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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