Provider Demographics
NPI:1003193285
Name:SALAZAR, CECILIA DE LAS MERCEDES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:DE LAS MERCEDES
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE 18TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3649
Mailing Address - Country:US
Mailing Address - Phone:561-201-1844
Mailing Address - Fax:
Practice Address - Street 1:850 IVES DAIRY RD STE T63
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2499
Practice Address - Country:US
Practice Address - Phone:305-654-9399
Practice Address - Fax:305-654-9359
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice