=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770286312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVETTE ALANIA SALAZAR DDS, MS, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2023
-----------------------------------------------------
Last Update Date | 03/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 W BALTIMORE ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-706-0550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 TOONE ST APT 2581
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-5168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-351-6773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 108
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------