Healthcare Provider Details

I. General information

NPI: 1235115395
Provider Name (Legal Business Name): JEFFERY MICHAEL SALERNO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 JOHNNYCAKE RIDGE RD
CONCORD TWP OH
44060-6752
US

IV. Provider business mailing address

1438 HENNING DR
LYNDHURST OH
44124-2421
US

V. Phone/Fax

Practice location:
  • Phone: 440-357-5555
  • Fax:
Mailing address:
  • Phone: 440-442-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: