Basic Information
| Provider Information | |||||||||
| NPI: | 1871832097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALWAN | ||||||||
| FirstName: | RITU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1507 S. 348TH STREET | ||||||||
| Address2: | SUITE K-102 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538353377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1955 W TEXAS ST | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074285400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60154107 | WA | Y | Dental Providers | Dentist | 1223G0001X | 64813 | CA | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1871832097 | 01 | CA | NPI | OTHER |