Provider Demographics
NPI:1164975827
Name:LA MASTRA, SALVATOR JOESPH V (DMD)
Entity Type:Individual
Prefix:DR
First Name:SALVATOR
Middle Name:JOESPH
Last Name:LA MASTRA
Suffix:V
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 1:8100 LOMO ALTO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6524
Mailing Address - Country:US
Mailing Address - Phone:214-363-9474
Mailing Address - Fax:
Practice Address - Street 1:8100 LOMO ALTO DR STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6524
Practice Address - Country:US
Practice Address - Phone:214-363-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32074122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist