Healthcare Provider Details

I. General information

NPI: 1477160661
Provider Name (Legal Business Name): ANTHONY SALEM D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SMITH RD STE 100
FAIRLAWN OH
44333-4449
US

IV. Provider business mailing address

3045 SMITH RD STE 100
FAIRLAWN OH
44333-4449
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-1165
  • Fax: 330-668-1169
Mailing address:
  • Phone: 330-668-1165
  • Fax: 330-668-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY MICHAEL SALEM
Title or Position: OWNER
Credential: DDS
Phone: 330-620-3637