Provider Demographics
NPI:1932408077
Name:SALZGEBER, R MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:R
Middle Name:MARTIN
Last Name:SALZGEBER
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 1:9914 W LINEBAUGH AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1858
Mailing Address - Country:US
Mailing Address - Phone:813-920-9144
Mailing Address - Fax:813-920-9155
Practice Address - Street 1:9914 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1858
Practice Address - Country:US
Practice Address - Phone:813-920-9144
Practice Address - Fax:813-920-9155
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 58641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics