Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401008189 | VA |
NPI | 1114000817 |
---|---|
Provider Name | Dr. Bruce T Sallen |
First Address | Falls Church, VA 22046 |
Second Address | Falls Church, VA 22046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |