Provider Demographics
NPI:1407438856
Name:SALOW, SYDNEY CULLOP
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CULLOP
Last Name:SALOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:NICOLE
Other - Last Name:CULLOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4010 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-6259
Mailing Address - Country:US
Mailing Address - Phone:606-547-6100
Mailing Address - Fax:
Practice Address - Street 1:500 WINCHESTER AVE STE 420
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7367
Practice Address - Country:US
Practice Address - Phone:606-324-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45321223G0001X
KY10588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice