Provider Demographics
NPI:1437198819
Name:SALEM PEABODY ORAL SURGERY
Entity Type:Organization
Organization Name:SALEM PEABODY ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-531-1450
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2905
Mailing Address - Country:US
Mailing Address - Phone:978-531-1450
Mailing Address - Fax:978-531-9984
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2905
Practice Address - Country:US
Practice Address - Phone:978-531-1450
Practice Address - Fax:978-531-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1437198819OtherNPI
MA1437198819OtherNPI