Provider Demographics
NPI:1912047531
Name:SALAZAR, DASSY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DASSY
Middle Name:R
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DASSY
Other - Middle Name:R
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9055 KATY FWY STE 308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1630
Mailing Address - Country:US
Mailing Address - Phone:713-464-6885
Mailing Address - Fax:
Practice Address - Street 1:9055 KATY FWY STE 308
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1630
Practice Address - Country:US
Practice Address - Phone:713-464-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1267718-04Medicaid