Healthcare Provider Details

I. General information

NPI: 1972713493
Provider Name (Legal Business Name): EUGENE SALAZAR DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E BELL RD STE 104
PHOENIX AZ
85022
US

IV. Provider business mailing address

16080 N 59TH AVE
GLENDALE AZ
85306-2339
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-7000
  • Fax: 602-482-7021
Mailing address:
  • Phone: 602-978-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD4147
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: