Provider Demographics
NPI:1275151235
Name:VEGA-SALAS, NATASHA ROSEMA (DDS)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ROSEMA
Last Name:VEGA-SALAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:ROSEMA
Other - Last Name:VEGA-VALBUENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5954 NEWCOMB ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3536
Mailing Address - Country:US
Mailing Address - Phone:954-279-0107
Mailing Address - Fax:
Practice Address - Street 1:7993 SIERRA AVE STE D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3330
Practice Address - Country:US
Practice Address - Phone:909-428-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist