Provider Demographics
NPI:1174619316
Name:SALOME, BRIAN CARTER (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARTER
Last Name:SALOME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7598 N MESA
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3518
Mailing Address - Country:US
Mailing Address - Phone:915-584-4472
Mailing Address - Fax:915-581-0737
Practice Address - Street 1:7598 N MESA
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3518
Practice Address - Country:US
Practice Address - Phone:915-584-4472
Practice Address - Fax:915-581-0737
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01483513OtherUNITED CONCORDIA
D21306OtherBCBS