Provider Demographics
NPI:1952656134
Name:DR. JEFFREY A. SALADIN, DENTAL CORP.
Entity Type:Organization
Organization Name:DR. JEFFREY A. SALADIN, DENTAL CORP.
Other - Org Name:CHILDREN'S CHOICE PEDIATRIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALADIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-473-1783
Mailing Address - Street 1:1164 NATIONAL DR STE 40
Mailing Address - Street 2:SUITE 40
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1925
Mailing Address - Country:US
Mailing Address - Phone:916-515-0005
Mailing Address - Fax:
Practice Address - Street 1:3309 FILLMORE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2710
Practice Address - Country:US
Practice Address - Phone:415-735-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JEFFREY A. SALADIN, DENTAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-13
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty