Provider Demographics
NPI:1023382710
Name:KEITH A. SALVATORI, DMD, P.C.
Entity Type:Organization
Organization Name:KEITH A. SALVATORI, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALVATORI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-757-2420
Mailing Address - Street 1:2050 MARKETPLACE DR
Mailing Address - Street 2:BURLINGTON CROSSING SHOPPING CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3207
Mailing Address - Country:US
Mailing Address - Phone:360-757-2420
Mailing Address - Fax:
Practice Address - Street 1:2050 MARKETPLACE DR
Practice Address - Street 2:BURLINGTON CROSSING SHOPPING CENTER
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3207
Practice Address - Country:US
Practice Address - Phone:360-757-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602334091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty