Provider Demographics
NPI:1437238060
Name:SALATA, LAWRENCE J (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:SALATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8562 NAVARRE RD SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-879-0121
Mailing Address - Fax:330-879-2082
Practice Address - Street 1:8562 NAVARRE RD SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-879-0121
Practice Address - Fax:330-879-2082
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist