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General NPI Number Information
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NPI Number | 1598045379
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Entity Type | Organization
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Legal Business Name | SALAZAR DENTAL LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 6219 BERGENLINE AVE 2ND FL
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1605
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Country | US
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Telephone | 201-861-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 6219 BERGENLINE AVE 2ND FL
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1605
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Country | US
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Telephone | 201-861-1007
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARIA JOSE SALAZAR
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Credential | D.M.D
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Telephone | 201-861-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI024160
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License Number State | NJ
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