Provider Demographics
NPI:1700915691
Name:SALAZAR, JOHN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5900 CUBERO DR NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3882
Mailing Address - Country:US
Mailing Address - Phone:505-856-1106
Mailing Address - Fax:505-797-0312
Practice Address - Street 1:5900 CUBERO DR NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3882
Practice Address - Country:US
Practice Address - Phone:505-856-1106
Practice Address - Fax:505-797-0312
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice