Provider Demographics
NPI:1649562893
Name:SALAS, RICHARD (DDS, MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SALAS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 LEXINGTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3637
Mailing Address - Country:US
Mailing Address - Phone:914-486-5600
Mailing Address - Fax:
Practice Address - Street 1:666 LEXINGTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3637
Practice Address - Country:US
Practice Address - Phone:212-746-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0591181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery