MEDICARE: DR. RICHARD R SALB 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	122300000X	Dentist	D07194	AZ
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D07194	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134132715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD R SALB DDS

Provider Business Mailing Address
First Line	:	2185 LEMOINE AVENUE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6036
Country	:	US
Telephone Number	:	201-947-4550
Fax Number	:	201-947-0971

Provider Business Practice Location Address
First Line	:	1526 W GLENDALE AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-277-5304
Fax Number	:	602-864-7736

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	01/21/2015

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