Provider Demographics
NPI:1306901244
Name:SALERNO, MICHAEL F (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:SALERNO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 LAKE ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1049
Mailing Address - Country:US
Mailing Address - Phone:708-848-8828
Mailing Address - Fax:708-848-7620
Practice Address - Street 1:1140 LAKE ST
Practice Address - Street 2:SUITE 503
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1049
Practice Address - Country:US
Practice Address - Phone:708-848-8828
Practice Address - Fax:708-848-7620
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-019554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist