Provider Demographics
NPI:1912405119
Name:SYLVIA SALEM DDS,INC.
Entity type:Organization
Organization Name:SYLVIA SALEM DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEMBRENO
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:626-332-7311
Mailing Address - Street 1:650 S FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-332-7311
Mailing Address - Fax:
Practice Address - Street 1:650 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3538
Practice Address - Country:US
Practice Address - Phone:626-332-7311
Practice Address - Fax:626-332-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47170261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental