Provider Demographics
NPI:1720191703
Name:SALAK, CATHY MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:SALAK
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 1:615 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472
Mailing Address - Country:US
Mailing Address - Phone:570-488-7280
Mailing Address - Fax:570-488-6550
Practice Address - Street 1:615 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472
Practice Address - Country:US
Practice Address - Phone:570-488-7280
Practice Address - Fax:570-488-6550
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029447L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist