MEDICARE: DR. JEFFREY A. SALADIN, DENTAL CORP.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1447741145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JEFFREY A. SALADIN, DENTAL CORP.

Provider Business Mailing Address
First Line	:	1164 NATIONAL DR STE 40
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 CARPINTERIA AVE STE 26
Second Line	:
City	:	CARPINTERIA
State	:	CA
Zip	:	93013-1446
Country	:	US
Telephone Number	:	833-306-7846
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTING SPECIALIST
Name	:	RIMA HAKIM
Credential	:
Telephone Number	:	415-295-6316

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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