Healthcare Provider Details

I. General information

NPI: 1689941155
Provider Name (Legal Business Name): TERESA MARY SALEM D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 NORTH FRANKLIN STREET
HOLBROOK MA
02343
US

IV. Provider business mailing address

12 PINECREST RD
HINGHAM MA
02043-3027
US

V. Phone/Fax

Practice location:
  • Phone: 781-767-0979
  • Fax:
Mailing address:
  • Phone: 781-740-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19021
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: