MEDICARE: SONRISAS FAMILY DENTAL

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	12011038A	IN
2	1223G0001X	General Practice Dentistry	12010930A	IN

General Provider Information

NPI Number	:	1801316864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONRISAS FAMILY DENTAL

Provider Business Mailing Address
First Line	:	3220 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3166
Country	:	US
Telephone Number	:	812-376-4054
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3166
Country	:	US
Telephone Number	:	812-376-4054
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARTIN SALAZAR
Credential	:	D.D.S.
Telephone Number	:	317-363-4760

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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Directions to “SONRISAS FAMILY DENTAL ” Practice Location

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