Basic Information
| Provider Information | |||||||||
| NPI: | 1558770222 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORSE DENTAL HEALTH CENTER JOAN SALIDO DDS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SMILES 4 LIFE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4655 MORSE CENTRE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432296601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144709840 | ||||||||
| FaxNumber: | 6144709841 | ||||||||
| Practice Location | |||||||||
| Address1: | 4655 MORSE CENTRE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432296601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144709840 | ||||||||
| FaxNumber: | 6144709841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2014 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | SALIDO | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6144709840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 20877 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.