Provider Demographics
NPI:1366578726
Name:SALERNO, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SALERNO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1219 MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769
Mailing Address - Country:US
Mailing Address - Phone:631-563-7462
Mailing Address - Fax:631-563-8930
Practice Address - Street 1:1219 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769
Practice Address - Country:US
Practice Address - Phone:631-563-7462
Practice Address - Fax:631-563-8930
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0379471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01060360Medicaid