Provider Demographics
NPI:1811124043
Name:SALLER, DENNIS P (DDS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:SALLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAKE WASHINGTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3400
Mailing Address - Country:US
Mailing Address - Phone:321-259-0866
Mailing Address - Fax:321-259-3260
Practice Address - Street 1:2900 LAKE WASHINGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3400
Practice Address - Country:US
Practice Address - Phone:321-259-0866
Practice Address - Fax:321-259-3260
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL94841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice