Provider Demographics
NPI:1619582756
Name:MARITZA SANCHEZ-SALAZAR DDS, PLC
Entity Type:Organization
Organization Name:MARITZA SANCHEZ-SALAZAR DDS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ-SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-300-8100
Mailing Address - Street 1:1578 N HWY 89, STE 1
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-7624
Mailing Address - Country:US
Mailing Address - Phone:928-300-8100
Mailing Address - Fax:
Practice Address - Street 1:1578 N HWY 89 STE 1
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-7624
Practice Address - Country:US
Practice Address - Phone:928-300-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444951Medicaid