Healthcare Provider Details

I. General information

NPI: 1649842691
Provider Name (Legal Business Name): DLR SALAZAR DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W EL NORTE PARKWAY SUITE #D
ESCONDIDO CA
92026
US

IV. Provider business mailing address

245 W EL NORTE PARKWAY SUITE #D
ESCONDIDO CA
92026
US

V. Phone/Fax

Practice location:
  • Phone: 760-740-0409
  • Fax: 760-740-0412
Mailing address:
  • Phone: 760-740-0409
  • Fax: 760-740-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO SALAZAR
Title or Position: OWNER/DDS
Credential: D.D.S
Phone: 760-740-0409