Provider Demographics
NPI:1275017337
Name:SALAR AND DELISLE LLC
Entity Type:Organization
Organization Name:SALAR AND DELISLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-968-0562
Mailing Address - Street 1:75 MOUNT ROSE ST STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3426
Mailing Address - Country:US
Mailing Address - Phone:775-971-4252
Mailing Address - Fax:
Practice Address - Street 1:75 MOUNT ROSE ST STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3426
Practice Address - Country:US
Practice Address - Phone:775-971-4252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty