Provider Demographics
NPI:1558024281
Name:SALIB-RASLA, KLARA GEORGY (DMD)
Entity type:Individual
Prefix:DR
First Name:KLARA
Middle Name:GEORGY
Last Name:SALIB-RASLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KLARA
Other - Middle Name:GEORGY
Other - Last Name:SALIB RASLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:702 MAIN ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1609
Mailing Address - Country:US
Mailing Address - Phone:781-812-9061
Mailing Address - Fax:
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist