Provider Demographics
NPI:1487713434
Name:SALAZAR DENTAL GROUP LLC
Entity type:Organization
Organization Name:SALAZAR DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-753-0404
Mailing Address - Street 1:6779 GREAT OAKS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-753-0404
Mailing Address - Fax:901-759-7931
Practice Address - Street 1:6779 GREAT OAKS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-753-0404
Practice Address - Fax:901-759-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty