MEDICARE: KELLY MARIE SALGADO

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	DN25562	FL

General Provider Information

NPI Number	:	1891398327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE SALGADO

Provider Business Mailing Address
First Line	:	13783 SW 21ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-1038
Country	:	US
Telephone Number	:	786-303-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 NE 8TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-4712
Country	:	US
Telephone Number	:	786-404-3791
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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