Provider Demographics
NPI:1659747061
Name:SALDIVAR, NATALIE RENEE (DMD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENEE
Last Name:SALDIVAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RENEE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6905 TURNBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2133
Mailing Address - Country:US
Mailing Address - Phone:208-308-5985
Mailing Address - Fax:
Practice Address - Street 1:10405 TIERRASANTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2603
Practice Address - Country:US
Practice Address - Phone:858-492-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4691122300000X
CADDS1056071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist