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	1223P0221X	Pediatric Dentistry	50143	CA

General Provider Information

NPI Number	:	1952656134
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	:	SUITE 40
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1925
Country	:	US
Telephone Number	:	916-515-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 FILLMORE ST
Second Line	:	SUITE A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2710
Country	:	US
Telephone Number	:	415-735-4374
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. JEFFREY A SALADIN
Credential	:	DDS
Telephone Number	:	916-473-1783

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/30/2015

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