Healthcare Provider Details

I. General information

NPI: 1700776861
Provider Name (Legal Business Name): CASSANDRA I SALAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SHADOW MOUNTAIN DR STE H
EL PASO TX
79912-4714
US

IV. Provider business mailing address

6 SIERRA CREST DR
EL PASO TX
79902-2161
US

V. Phone/Fax

Practice location:
  • Phone: 915-519-1070
  • Fax:
Mailing address:
  • Phone: 915-433-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: