Provider Demographics
NPI:1942579313
Name:SALEM, SYLVIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:A
Last Name:SALEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 CALLE CRISTINA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4458
Mailing Address - Country:US
Mailing Address - Phone:909-229-9102
Mailing Address - Fax:626-335-7911
Practice Address - Street 1:650 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3538
Practice Address - Country:US
Practice Address - Phone:626-332-7311
Practice Address - Fax:626-332-0052
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist