Provider Demographics
NPI:1740018472
Name:PRIETO SALCIDO, GLADIS LEOGARDA
Entity type:Individual
Prefix:
First Name:GLADIS
Middle Name:LEOGARDA
Last Name:PRIETO SALCIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 DUSK VIEW ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-215-9491
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE LA VICTORIA #4370
Practice Address - Street 2:
Practice Address - City:CD.JUAREZ
Practice Address - State:CHH
Practice Address - Zip Code:32618
Practice Address - Country:MX
Practice Address - Phone:915-215-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ71706331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice