Provider Demographics
NPI:1073975207
Name:SALIBA, JESSICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:SALIBA
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 1:155 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1680
Mailing Address - Country:US
Mailing Address - Phone:201-704-5223
Mailing Address - Fax:
Practice Address - Street 1:155 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1680
Practice Address - Country:US
Practice Address - Phone:201-704-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS041197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program