Provider Demographics
NPI:1457435125
Name:GERARD D. SALVOSA D.M.D. INC.
Entity Type:Organization
Organization Name:GERARD D. SALVOSA D.M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:DURANTE
Authorized Official - Last Name:SALVOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-779-6888
Mailing Address - Street 1:20655 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7110
Mailing Address - Country:US
Mailing Address - Phone:714-779-6888
Mailing Address - Fax:714-779-8828
Practice Address - Street 1:20655 YORBA LINDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7110
Practice Address - Country:US
Practice Address - Phone:714-779-6888
Practice Address - Fax:714-779-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44253261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental