Provider Demographics
NPI:1871623389
Name:SALAZAR, ROLANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR.
Mailing Address - Street 2:#316
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-696-7500
Mailing Address - Fax:956-795-1040
Practice Address - Street 1:5282 MEDICAL DR.
Practice Address - Street 2:#316
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6044
Practice Address - Country:US
Practice Address - Phone:210-696-7500
Practice Address - Fax:210-692-0248
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213541223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159348509Medicaid
TX159348501Medicaid