Provider Demographics
NPI:1437238417
Name:SALAZAR, JUAN CARLOS E (DDS)
Entity type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:E
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 1:6130 NE 7TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4590
Mailing Address - Country:US
Mailing Address - Phone:425-306-7321
Mailing Address - Fax:
Practice Address - Street 1:3200 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3335
Practice Address - Country:US
Practice Address - Phone:425-228-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010047122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0042374788Medicaid
WA5049044Medicaid