Provider Demographics
NPI:1073647780
Name:SOUZA, SALVATORE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:G
Last Name:SOUZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAL
Other - Middle Name:G
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1168 OLIVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1210
Mailing Address - Country:US
Mailing Address - Phone:209-383-9370
Mailing Address - Fax:209-383-6732
Practice Address - Street 1:1168 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1210
Practice Address - Country:US
Practice Address - Phone:209-383-9370
Practice Address - Fax:209-383-6732
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37926OtherDDS
37926OtherDDS