Healthcare Provider Details

I. General information

NPI: 1629579628
Provider Name (Legal Business Name): ALFONSO SALCINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6641 S DIXIE HWY # A
MIAMI FL
33143-7919
US

IV. Provider business mailing address

6641 S DIXIE HWY # A
MIAMI FL
33143-7919
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-0306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME170566
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN29481
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number40790
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: