Provider Demographics
NPI:1639475023
Name:TEVES SALAZAR, GUSTAVO A (DDS)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
Last Name:TEVES SALAZAR
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 1:13341 SW 110TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4351
Mailing Address - Country:US
Mailing Address - Phone:305-510-1987
Mailing Address - Fax:
Practice Address - Street 1:13341 SW 110TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4351
Practice Address - Country:US
Practice Address - Phone:305-510-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice