Provider Demographics
NPI:1295343739
Name:KEVIN JAMES SALINAS, DDS, PC
Entity type:Organization
Organization Name:KEVIN JAMES SALINAS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-230-2579
Mailing Address - Street 1:13175 MARINA WAY APT 509
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1277
Mailing Address - Country:US
Mailing Address - Phone:202-230-2579
Mailing Address - Fax:
Practice Address - Street 1:4893 PRINCE WILLIAM PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5404
Practice Address - Country:US
Practice Address - Phone:703-494-2226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401416542OtherVA DENTAL LICENSE