Provider Demographics
NPI:1154534238
Name:SALEM DENTISTRY P.C.
Entity type:Organization
Organization Name:SALEM DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-447-7147
Mailing Address - Street 1:107 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2249
Mailing Address - Country:US
Mailing Address - Phone:802-447-7147
Mailing Address - Fax:
Practice Address - Street 1:107 ELM ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2249
Practice Address - Country:US
Practice Address - Phone:802-447-7147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-0001238261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental