Provider Demographics
NPI:1053401075
Name:SALVOSA, GERARD DURANTE (DMD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:DURANTE
Last Name:SALVOSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20655 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7110
Mailing Address - Country:US
Mailing Address - Phone:714-779-6888
Mailing Address - Fax:714-779-8828
Practice Address - Street 1:20655 YORBA LINDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7110
Practice Address - Country:US
Practice Address - Phone:714-779-6888
Practice Address - Fax:714-779-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice