Provider Demographics
NPI:1558586701
Name:SALAMY, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:SALAMY
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 1:15835 POMERADO RD STE 301
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2043
Mailing Address - Country:US
Mailing Address - Phone:858-487-4888
Mailing Address - Fax:858-487-0717
Practice Address - Street 1:15835 POMERADO RD STE 301
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2043
Practice Address - Country:US
Practice Address - Phone:858-487-4888
Practice Address - Fax:858-487-0717
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist