Healthcare Provider Details

I. General information

NPI: 1952771081
Provider Name (Legal Business Name): JAMES L SALTZGIVER JR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CLINE AVE
MANSFIELD OH
44907-1057
US

IV. Provider business mailing address

370 CLINE AVE
MANSFIELD OH
44907-1057
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-1379
  • Fax: 419-756-2614
Mailing address:
  • Phone: 419-756-1379
  • Fax: 419-756-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30032853
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES L SALTZGIVER JR.
Title or Position: DENTIST
Credential: DDS
Phone: 419-756-1379