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General NPI Number Information
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NPI Number | 1134378276
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Entity Type | Individual
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Provider Name | GUSTAVO SALAS D.D.S; M.S
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Gender | Male
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 14740 BARRYKNOLL LN SUITE 160
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City | HOUSTON
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State | TX
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Zip | 77079-2884
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Country | US
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Telephone | 281-589-6100
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Fax | 281-752-0256
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Provider Business Mailing Address
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Address Line | 3318 WRANGLER SKY CT
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City | KATY
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State | TX
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Zip | 77494-2770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 24248
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24248
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License Number State | TX
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