Provider Demographics
NPI:1518981653
Name:SALEMA, MARK KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
Last Name:SALEMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVENUE N.E. D20
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3002
Mailing Address - Country:US
Mailing Address - Phone:425-821-5648
Mailing Address - Fax:425-820-3497
Practice Address - Street 1:12819 120TH AVENUE NE
Practice Address - Street 2:SUITE I
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3002
Practice Address - Country:US
Practice Address - Phone:425-821-5648
Practice Address - Fax:425-820-3497
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist