Provider Demographics
NPI:1780950279
Name:ROBLES SALAS, VANESZA (MPH, DMD)
Entity type:Individual
Prefix:DR
First Name:VANESZA
Middle Name:
Last Name:ROBLES SALAS
Suffix:
Gender:F
Credentials:MPH, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MOUNT SINAI AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2312
Mailing Address - Country:US
Mailing Address - Phone:631-347-6333
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL DR STE D
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1597
Practice Address - Country:US
Practice Address - Phone:631-928-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0568201223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program