MEDICARE: DALE SALOMON DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15354	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245333509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE SALOMON DMD

Provider Business Mailing Address
First Line	:	7720 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1813
Country	:	US
Telephone Number	:	813-885-6555
Fax Number	:	813-882-8018

Provider Business Practice Location Address
First Line	:	14815 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2027
Country	:	US
Telephone Number	:	813-264-1993
Fax Number	:

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/28/2019

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Directions to “ DALE SALOMON DMD” Practice Location

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