Provider Demographics
NPI:1013068113
Name:SALAZAR, EVELYN LUGUE (DDS)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:LUGUE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 OLD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4148
Mailing Address - Country:US
Mailing Address - Phone:619-271-8682
Mailing Address - Fax:
Practice Address - Street 1:1101 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2706
Practice Address - Country:US
Practice Address - Phone:619-422-8891
Practice Address - Fax:619-422-4356
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist