Provider Demographics
NPI:1962540450
Name:SALAS, JOSEPH J (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:SALAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2306
Mailing Address - Country:US
Mailing Address - Phone:941-708-5110
Mailing Address - Fax:941-708-5120
Practice Address - Street 1:6607 3RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2306
Practice Address - Country:US
Practice Address - Phone:941-708-5110
Practice Address - Fax:941-708-5120
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice