Healthcare Provider Details

I. General information

NPI: 1538237912
Provider Name (Legal Business Name): ARMANDO SALAZAR DMD, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12002 SW 128TH CT STE 108
MIAMI FL
33186-4639
US

IV. Provider business mailing address

12002 SW 128TH CT STE 108
MIAMI FL
33186-4639
US

V. Phone/Fax

Practice location:
  • Phone: 305-238-5537
  • Fax: 305-238-5062
Mailing address:
  • Phone: 305-238-5537
  • Fax: 305-238-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21689
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 18556
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 18556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: