=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629212113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALISBURY & DRISCOLL, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2009
-----------------------------------------------------
Last Update Date | 04/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 WESTBROOK PLAZA DR SUITE 203
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-1355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-765-0904
-----------------------------------------------------
Fax | 336-765-3422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 WESTBROOK PLAZA DR SUITE 203
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-1355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-765-0904
-----------------------------------------------------
Fax | 336-765-3422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. DANIEL F. DRISCOLL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 336-765-0904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 2679
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------