Provider Demographics
NPI:1699789651
Name:SALEM FAMILY DENTAL PC
Entity type:Organization
Organization Name:SALEM FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-898-1450
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:SALEM FAMILY DENTAL
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-898-1450
Mailing Address - Fax:603-893-8751
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:SALEM FAMILY DENTAL
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-898-1450
Practice Address - Fax:603-893-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22781223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty