Healthcare Provider Details

I. General information

NPI: 1437198819
Provider Name (Legal Business Name): SALEM PEABODY ORAL SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/30/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ESSEX CENTER DR
PEABODY MA
01960-2905
US

IV. Provider business mailing address

6 ESSEX CENTER DR
PEABODY MA
01960-2905
US

V. Phone/Fax

Practice location:
  • Phone: 978-531-1450
  • Fax: 978-531-9984
Mailing address:
  • Phone: 978-531-1450
  • Fax: 978-531-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JEFF BLAESER
Title or Position: PRACTICE ADMIN
Credential:
Phone: 978-531-1450