MEDICARE: DR. MARCO V SALAZAR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN12999	FL

General Provider Information

NPI Number	:	1568580710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCO V SALAZAR D.D.S.

Provider Business Mailing Address
First Line	:	4895 WINDWARD PASSAGE DR
Second Line	:	SUITE 12
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-7741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4895 WINDWARD PASSAGE DR
Second Line	:	SUITE 12
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-7741
Country	:	US
Telephone Number	:	561-870-3041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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