Provider Demographics
NPI:1427208214
Name:SALAZAR DENTAL OF INDIANA INC
Entity Type:Organization
Organization Name:SALAZAR DENTAL OF INDIANA INC
Other - Org Name:SALAZAR FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-363-4760
Mailing Address - Street 1:2001 W WASHINGTON ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-4299
Mailing Address - Country:US
Mailing Address - Phone:317-636-2002
Mailing Address - Fax:317-803-3327
Practice Address - Street 1:2001 W WASHINGTON ST
Practice Address - Street 2:SUITE B2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-4299
Practice Address - Country:US
Practice Address - Phone:317-636-2002
Practice Address - Fax:317-803-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty