Provider Demographics
NPI:1083730428
Name:NORTON FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:NORTON FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-226-1686
Mailing Address - Street 1:275 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2104
Mailing Address - Country:US
Mailing Address - Phone:508-226-1686
Mailing Address - Fax:508-226-2686
Practice Address - Street 1:275 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2104
Practice Address - Country:US
Practice Address - Phone:508-226-1686
Practice Address - Fax:508-226-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty