Healthcare Provider Details

I. General information

NPI: 1518944172
Provider Name (Legal Business Name): JERRY W SALO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WORCESTER RD
STERLING MA
01564-1434
US

IV. Provider business mailing address

32 WORCESTER RD PO BOX 459
STERLING MA
01564-1434
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-7314
  • Fax:
Mailing address:
  • Phone: 978-422-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberMA13837
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: