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Individual

DALE GRAHAM SALATICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
745 N MAGNOLIA AVE., SUITE 201, ORLANDO, FL 32803-3835
(407) 299-7333
Mailing address
745 N MAGNOLIA AVE., SUITE 201, ORLANDO, FL 32803-3835
(407) 299-7333

Taxonomy

Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
ME53091
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
049534400
FL
01
05974
BLUE CROSS BLUE SHIELD
FL
01
4071383
AETNA PROVIDER ID
FL
01
623763
AENTA PROVIDER ID
FL
01
FEIN
593490701
FL
Enumeration date
05/31/2005
Last updated
10/20/2013
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