Provider Demographics
NPI:1134378276
Name:SALAS, GUSTAVO (DDS; MS)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:SALAS
Suffix:
Gender:M
Credentials:DDS; MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 WRANGLER SKY CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14740 BARRYKNOLL LN
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2884
Practice Address - Country:US
Practice Address - Phone:281-589-6100
Practice Address - Fax:281-752-0256
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242481223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice