Provider Demographics
NPI:1871643288
Name:ROBLES, CHRISTLINE SALVADOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTLINE
Middle Name:SALVADOR
Last Name:ROBLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTLINE
Other - Middle Name:
Other - Last Name:SALVADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:8215 VAN NUYS BLVD
Mailing Address - Street 2:STE. 216
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4810
Mailing Address - Country:US
Mailing Address - Phone:818-997-8097
Mailing Address - Fax:818-997-1202
Practice Address - Street 1:8215 VAN NUYS BLVD
Practice Address - Street 2:STE. 216
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4810
Practice Address - Country:US
Practice Address - Phone:818-997-8097
Practice Address - Fax:818-997-1202
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41783-01Medicaid