Provider Demographics
NPI:1366465221
Name:SALO, LEANN CLARICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:CLARICE
Last Name:SALO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 VINEWOOD LN N
Mailing Address - Street 2:#13
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1155
Mailing Address - Country:US
Mailing Address - Phone:763-557-6893
Mailing Address - Fax:763-550-0744
Practice Address - Street 1:3900 VINEWOOD LN N
Practice Address - Street 2:#13
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1155
Practice Address - Country:US
Practice Address - Phone:763-557-6893
Practice Address - Fax:763-550-0744
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice