Provider Demographics
NPI:1356632715
Name:PANAMA CITY DENTAL STUDIO
Entity Type:Organization
Organization Name:PANAMA CITY DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-784-0700
Mailing Address - Street 1:2410 SAINT ANDREWS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2135
Mailing Address - Country:US
Mailing Address - Phone:850-784-0700
Mailing Address - Fax:850-784-0903
Practice Address - Street 1:2410 SAINT ANDREWS BLVD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2135
Practice Address - Country:US
Practice Address - Phone:850-784-0700
Practice Address - Fax:850-784-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8608261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1396810024Other087