Provider Demographics
NPI:1134483001
Name:SALAS, EDGAR F (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:F
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 1:1131 TOLLAND TPKE STE J
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1679
Mailing Address - Country:US
Mailing Address - Phone:860-533-7270
Mailing Address - Fax:
Practice Address - Street 1:1131 TOLLAND TPKE STE J
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1679
Practice Address - Country:US
Practice Address - Phone:860-533-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid