Healthcare Provider Details

I. General information

NPI: 1003820663
Provider Name (Legal Business Name): CLIFFORD SALM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 60TH ST SUITE 608
NEW YORK NY
10022-1082
US

IV. Provider business mailing address

30 EAST 60TH STREET SUITE 608
NEW YORK NY
10022-1082
US

V. Phone/Fax

Practice location:
  • Phone: 212-308-3222
  • Fax: 212-888-3581
Mailing address:
  • Phone: 212-308-3222
  • Fax: 212-888-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number035713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: