Provider Demographics
NPI:1922047323
Name:RICARDO SALINAS CLINIC
Entity Type:Organization
Organization Name:RICARDO SALINAS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-450-3318
Mailing Address - Street 1:PO BOX 40397
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1397
Mailing Address - Country:US
Mailing Address - Phone:210-567-6405
Mailing Address - Fax:210-567-2844
Practice Address - Street 1:630 N GENERAL MCMULLEN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-6215
Practice Address - Country:US
Practice Address - Phone:210-436-0098
Practice Address - Fax:210-433-0643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTHSCSA DENTAL SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2018-01-25
Deactivation Date:2017-10-09
Deactivation Code:
Reactivation Date:2017-10-24
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60211-01OtherCHIP
TX178118901Medicaid