Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN22576 | FL |
NPI | 1003330416 |
---|---|
Provider Name | Dr. Felipe Salles |
First Address | Lithia, FL 33547-3800 |
Second Address | Lithia, FL 33547-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 27/07/2017 |