Provider Demographics
NPI:1508109810
Name:LEON SALAZAR, VLADIMIR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:LEON SALAZAR
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:VLADIMIR
Other - Middle Name:
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:5870 BLACKSHIRE PATH
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1620
Mailing Address - Country:US
Mailing Address - Phone:651-433-7200
Mailing Address - Fax:
Practice Address - Street 1:5870 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1620
Practice Address - Country:US
Practice Address - Phone:651-433-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS120122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist