Healthcare Provider Details

I. General information

NPI: 1245671155
Provider Name (Legal Business Name): MABEL LEONOR SALAS MARTINEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MABEL LEONOR SALAS MARTINEZ DDS

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2127
  • Fax:
Mailing address:
  • Phone: 816-235-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2013022285
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: