Provider Demographics
NPI:1134132715
Name:SALB, RICHARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:SALB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 LEMOINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6036
Mailing Address - Country:US
Mailing Address - Phone:201-947-4550
Mailing Address - Fax:201-947-0971
Practice Address - Street 1:1526 W GLENDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8576
Practice Address - Country:US
Practice Address - Phone:602-277-5304
Practice Address - Fax:602-864-7736
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07194122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ340581Medicaid
SA025305Medicare UPIN
17AU02537Medicare ID - Type Unspecified