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General NPI Number Information
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NPI Number | 1255761599
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Entity Type | Organization
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Legal Business Name | JUAN CARLOS SALAZAR, DDS, PS
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Dates
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Enumeration Date | 11/23/2013
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Last Update Date | 11/23/2013
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Provider Practice Location Address
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Address Line | 3200 NE SUNSET BLVD
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City | RENTON
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State | WA
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Zip | 98056-3335
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Country | US
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Telephone | 425-228-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 6130 NE 7TH CT
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City | RENTON
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State | WA
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Zip | 98059-4590
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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 | PRESIDENT
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Name | JUAN CARLOS SALAZAR
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Credential |
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Telephone | 425-226-7287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE00010047
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License Number State | WA
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