MEDICARE: DR. MAYSSA SALTI

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	0401415857	VA

General Provider Information

NPI Number	:	1922506336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYSSA SALTI

Provider Business Mailing Address
First Line	:	465 BRANTWOOD RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14226-4641
Country	:	US
Telephone Number	:	716-319-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	9221 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6876
Country	:	US
Telephone Number	:	804-330-0508
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	03/17/2018

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