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NPI Code Detail

MEDICARE: SALKELD FAMILY DENTAL, LLC

MEDICARE: SALKELD FAMILY DENTAL, LLC
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
1122300000XDentist12009491AIN

General Provider Information

NPI Number : 1891120382
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALKELD FAMILY DENTAL, LLC
Provider Business Mailing Address
First Line : 12962 COLDWATER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9517
Country : US
Telephone Number : 260-637-4648
Fax Number :
Provider Business Practice Location Address
First Line : 12962 COLDWATER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9517
Country : US
Telephone Number : 260-637-4648
Fax Number :
Authorized Official
Title or Position : OWNER
Name : STEVEN CHARLES SALKELD
Credential : DDS
Telephone Number : 260-637-4648
Provider Enumeration Date : 09/04/2013
Last Update Date : 09/23/2020

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