Provider Demographics
NPI:1538284575
Name:SALINAS & VENTURA THE FAMILY DENTIST
Entity Type:Organization
Organization Name:SALINAS & VENTURA THE FAMILY DENTIST
Other - Org Name:ELBA VENTURA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-350-9800
Mailing Address - Street 1:105A 107 FRANK E RODGERS BLVD N
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029
Mailing Address - Country:US
Mailing Address - Phone:973-350-9800
Mailing Address - Fax:973-350-0450
Practice Address - Street 1:105A 107 FRANK E RODGERS BLVD N
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029
Practice Address - Country:US
Practice Address - Phone:973-350-9800
Practice Address - Fax:973-350-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ828670101Medicaid