Provider Demographics
NPI:1992978092
Name:SALKO, RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SALKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 BAYMEADOWS RD E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9675
Mailing Address - Country:US
Mailing Address - Phone:904-997-1177
Mailing Address - Fax:904-997-1108
Practice Address - Street 1:7711 BAYMEADOWS RD E
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9675
Practice Address - Country:US
Practice Address - Phone:904-997-1177
Practice Address - Fax:904-997-1108
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist