Provider Demographics
NPI:1710196977
Name:LA SALVIA, JOAN NINON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:NINON
Last Name:LA SALVIA
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 1:100 NW 82ND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1899
Mailing Address - Country:US
Mailing Address - Phone:954-475-9455
Mailing Address - Fax:954-475-9931
Practice Address - Street 1:100 NW 82ND AVE STE 203
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1899
Practice Address - Country:US
Practice Address - Phone:954-475-9455
Practice Address - Fax:954-475-9931
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN233881223G0001X
FL233881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1015941OtherTUFTS EMPOYER ID