MEDICARE: MR. JOSE LUIS SALAZAR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8109	TN

General Provider Information

NPI Number	:	1528131414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE LUIS SALAZAR DDS

Provider Business Mailing Address
First Line	:	9919 ABERLOUR DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38016
Country	:	US
Telephone Number	:	901-753-0404
Fax Number	:	901-759-7931

Provider Business Practice Location Address
First Line	:	6799 GREAT OAKS RD
Second Line	:	SUITE 201
City	:	MEMPHIS
State	:	TN
Zip	:	38138
Country	:	US
Telephone Number	:	901-753-0404
Fax Number	:	901-759-7931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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