Healthcare Provider Details

I. General information

NPI: 1174363311
Provider Name (Legal Business Name): AYLIN GALLEGOS SALAZAR DMD,CAGCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SIMON ST
NASHUA NH
03060-3046
US

IV. Provider business mailing address

130 WALNUT ST APT B
SOMERVILLE MA
02145-2953
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-4700
  • Fax:
Mailing address:
  • Phone: 781-827-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number05061
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: