Provider Demographics
NPI:1508229907
Name:DWIGHT SALMON DDS PA
Entity Type:Organization
Organization Name:DWIGHT SALMON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-652-5455
Mailing Address - Street 1:20320 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2503
Mailing Address - Country:US
Mailing Address - Phone:305-652-5455
Mailing Address - Fax:
Practice Address - Street 1:20320 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2503
Practice Address - Country:US
Practice Address - Phone:305-652-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty