Provider Demographics
NPI:1174363311
Name:GALLEGOS SALAZAR, AYLIN (DMD,CAGCS)
Entity type:Individual
Prefix:
First Name:AYLIN
Middle Name:
Last Name:GALLEGOS SALAZAR
Suffix:
Gender:F
Credentials:DMD,CAGCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WALNUT ST APT B
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2953
Mailing Address - Country:US
Mailing Address - Phone:781-827-9802
Mailing Address - Fax:
Practice Address - Street 1:39 SIMON ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-880-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH050611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty