Provider Demographics
NPI:1386890598
Name:SALAITA, NICHOLAS GEORGE (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:SALAITA
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1523 W AVENUE J
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2819
Mailing Address - Country:US
Mailing Address - Phone:661-942-4353
Mailing Address - Fax:661-940-6064
Practice Address - Street 1:1523 W AVENUE J
Practice Address - Street 2:SUITE #3
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2819
Practice Address - Country:US
Practice Address - Phone:661-942-4353
Practice Address - Fax:661-940-6064
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA393291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery