Provider Demographics
NPI:1407279995
Name:SALAZAR-PONGS, MARLENE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:R
Last Name:SALAZAR-PONGS
Suffix:
Gender:F
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:PO BOX 7545
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513
Mailing Address - Country:US
Mailing Address - Phone:951-897-2876
Mailing Address - Fax:951-688-4091
Practice Address - Street 1:106 N EUCALYPTUS AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-875-1299
Practice Address - Fax:909-875-0101
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice