Basic Information
| Provider Information | |||||||||
| NPI: | 1134615628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALCEDO | ||||||||
| FirstName: | CARLISLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 26424 REDLANDS BLVD APT 54 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923736203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628589430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 422 ORANGE ST | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923743206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097927500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2018 | ||||||||
| LastUpdateDate: | 07/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 102644 | CA | Y | Dental Providers | Dentist |
No ID Information.