Provider Demographics
NPI:1609961796
Name:SALTZ, TIDA K L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIDA
Middle Name:K L
Last Name:SALTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 S EASTERN AVE
Mailing Address - Street 2:STE 122
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-765-5400
Mailing Address - Fax:702-765-5444
Practice Address - Street 1:9310 S EASTERN AVE
Practice Address - Street 2:STE 122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123
Practice Address - Country:US
Practice Address - Phone:702-765-5400
Practice Address - Fax:702-765-5444
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice