Provider Demographics
NPI:1326565573
Name:SALAZAR, PAOLA YASMIN (RDH)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:YASMIN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W VERNON CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-3814
Mailing Address - Country:US
Mailing Address - Phone:703-774-8292
Mailing Address - Fax:
Practice Address - Street 1:3400 PAYNE ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2313
Practice Address - Country:US
Practice Address - Phone:703-578-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207299124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist