Healthcare Provider Details

I. General information

NPI: 1790302503
Provider Name (Legal Business Name): SEBASTIEN RICHARD SALZMANN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH ST
PITTSFIELD MA
01201-6892
US

IV. Provider business mailing address

105 LAUREL ST APT 11A
LEE MA
01238-1222
US

V. Phone/Fax

Practice location:
  • Phone: 413-445-4592
  • Fax:
Mailing address:
  • Phone: 407-800-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1858811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: