Provider Demographics
NPI:1053606855
Name:SALA, STEPHEN L (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:SALA
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 1:8030 CORPORATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1245
Mailing Address - Country:US
Mailing Address - Phone:440-845-7300
Mailing Address - Fax:440-845-7785
Practice Address - Street 1:8030 CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1245
Practice Address - Country:US
Practice Address - Phone:440-845-7300
Practice Address - Fax:440-845-7785
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0236171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice