Provider Demographics
NPI:1679911473
Name:ELSEMARY AND SALEM DENTAL CORPORATION
Entity type:Organization
Organization Name:ELSEMARY AND SALEM DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-683-3841
Mailing Address - Street 1:9045 BRUCEVILLE RD
Mailing Address - Street 2:SUITE #160
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5948
Mailing Address - Country:US
Mailing Address - Phone:916-683-3841
Mailing Address - Fax:916-683-3848
Practice Address - Street 1:9045 BRUCEVILLE RD
Practice Address - Street 2:SUITE #160
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5948
Practice Address - Country:US
Practice Address - Phone:916-683-3841
Practice Address - Fax:916-683-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503641223G0001X
CA478821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty