Provider Demographics
NPI:1700143724
Name:SALA, MARISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:SALA
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 1:625 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1589
Mailing Address - Country:US
Mailing Address - Phone:201-670-9076
Mailing Address - Fax:
Practice Address - Street 1:625 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1589
Practice Address - Country:US
Practice Address - Phone:201-670-9076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055969122300000X
NJ22DI02493600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist