Provider Demographics
NPI:1821430497
Name:SALMERON, YULIYA
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:SALMERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 S BILL MARTIN DR
Mailing Address - Street 2:APT 13203
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-5138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 NORTHCHASE PKWY SE
Practice Address - Street 2:SUITE 290
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6405
Practice Address - Country:US
Practice Address - Phone:770-916-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid