MEDICARE: GUSTAVO A. TEVES SALAZAR D.D.S.

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	1223G0001X	General Practice Dentistry	60114	CA

General Provider Information

NPI Number	:	1639475023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO A. TEVES SALAZAR D.D.S.

Provider Business Mailing Address
First Line	:	13341 SW 110TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4351
Country	:	US
Telephone Number	:	305-510-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	13341 SW 110TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4351
Country	:	US
Telephone Number	:	305-510-1987
Fax Number	:

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

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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