Healthcare Provider Details

I. General information

NPI: 1609979012
Provider Name (Legal Business Name): JEFFREY IAN SALTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 STATE RD SUITE 102
KITTERY ME
03904-1564
US

IV. Provider business mailing address

74 STATE RD SUITE 102
KITTERY ME
03904-1564
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-5413
  • Fax:
Mailing address:
  • Phone: 207-439-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3257
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: