MEDICARE: DR. MICHAEL ANDREW SALAZAR DN 12958

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	1223G0001X	General Practice Dentistry	DN 12958	FL

General Provider Information

NPI Number	:	1770990780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANDREW SALAZAR DN 12958

Provider Business Mailing Address
First Line	:	4755 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	407-855-1128
Fax Number	:	407-855-1130

Provider Business Practice Location Address
First Line	:	4755 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	407-855-1128
Fax Number	:	407-855-1130

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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