Healthcare Provider Details

I. General information

NPI: 1801906607
Provider Name (Legal Business Name): JANICE NOEL SALAZAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 CERRILLOS RD #1202
SANTA FE NM
87507-4697
US

IV. Provider business mailing address

PO BOX 29476
SANTA FE NM
87592-9476
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4867
  • Fax: 505-424-8535
Mailing address:
  • Phone: 505-982-4867
  • Fax: 505-424-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2779
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: