Provider Demographics
NPI:1205857893
Name:MARLENE K. SALIB, DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARLENE K. SALIB, DDS A PROFESSIONAL CORPORATION
Other - Org Name:THE VILLAGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:SALIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-945-1684
Mailing Address - Street 1:6742 GREENLEAF AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-5154
Mailing Address - Country:US
Mailing Address - Phone:562-945-1684
Mailing Address - Fax:562-696-6454
Practice Address - Street 1:6742 GREENLEAF AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-5154
Practice Address - Country:US
Practice Address - Phone:562-945-1684
Practice Address - Fax:562-696-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicare UPIN