Provider Demographics
NPI:1710082730
Name:SALTER, BRAD H (DDS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:H
Last Name:SALTER
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 1:6617 HERITAGE PKWY
Mailing Address - Street 2:SUITE #120
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8750
Mailing Address - Country:US
Mailing Address - Phone:972-412-0014
Mailing Address - Fax:972-475-9229
Practice Address - Street 1:6617 HERITAGE PKWY
Practice Address - Street 2:SUITE #120
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8750
Practice Address - Country:US
Practice Address - Phone:972-412-0014
Practice Address - Fax:972-475-9229
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice