Provider Demographics
NPI:1679956593
Name:SALAZAR, LUIS ALONSO JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALONSO
Last Name:SALAZAR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 S DECATUR BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6840
Mailing Address - Country:US
Mailing Address - Phone:702-795-7771
Mailing Address - Fax:
Practice Address - Street 1:4270 S DECATUR BLVD STE A2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6840
Practice Address - Country:US
Practice Address - Phone:702-795-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist