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Individual

DR. EDWARD TRACY SALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD,DDS

Contact information

Practice address
4000 MEDICAL CENTER DR., STE 404, FAYETTEVILLE, NY 13066
(315) 234-9865
Mailing address
5471 KEARNY VILLA RD STE 200, SAN DIEGO, CA 92123-1143
(866) 801-9440

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
104553
CA
207YX0602X
Otolaryngic Allergy Physician
Primary
181365
NY

Other

Enumeration date
11/30/2005
Last updated
06/18/2024
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