Healthcare Provider Details

I. General information

NPI: 1023707791
Provider Name (Legal Business Name): ADRIAN SALINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LORENALY DR
BROWNSVILLE TX
78526-4060
US

IV. Provider business mailing address

1500 PARK AVE
ST LOUIS MO
63104
US

V. Phone/Fax

Practice location:
  • Phone: 956-542-9200
  • Fax:
Mailing address:
  • Phone: 314-833-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: