Provider Demographics
NPI:1700543378
Name:TIMOTHY S SALIB DMD PA
Entity Type:Organization
Organization Name:TIMOTHY S SALIB DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALIB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-759-1462
Mailing Address - Street 1:718 SE BECKER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984
Mailing Address - Country:US
Mailing Address - Phone:772-336-2300
Mailing Address - Fax:
Practice Address - Street 1:718 SE BECKER RD
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984
Practice Address - Country:US
Practice Address - Phone:772-336-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty