Provider Demographics
NPI:1639435191
Name:ROCKSTAR FAMILY DENTAL PRACTICE OF DR GINA L SALATINO
Entity type:Organization
Organization Name:ROCKSTAR FAMILY DENTAL PRACTICE OF DR GINA L SALATINO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:SALATINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-771-7873
Mailing Address - Street 1:3071 STANFORD RANCH RD STE C3
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:916-771-7873
Mailing Address - Fax:916-435-8234
Practice Address - Street 1:3071 STANFORD RANCH RD STE C3
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765
Practice Address - Country:US
Practice Address - Phone:916-771-7873
Practice Address - Fax:916-435-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty