Provider Demographics
NPI:1972641645
Name:SALAZAR, BLANCA L (DDS)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:L
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2933
Mailing Address - Country:US
Mailing Address - Phone:708-656-1841
Mailing Address - Fax:708-656-1869
Practice Address - Street 1:5008 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2933
Practice Address - Country:US
Practice Address - Phone:708-656-1841
Practice Address - Fax:708-656-1869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190200271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice