Individual
YANISA ALEXANDRA STUART SALAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Mailing address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN28355
FL
390200000X
Student in an Organized Health Care Education/Training Program
37838587
FL
Other
Enumeration date
03/09/2023
Last updated
08/13/2024
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