Provider Demographics
NPI:1518944172
Name:SALO, JERRY W (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:SALO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WORCESTER RD
Mailing Address - Street 2:PO BOX 459
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-1434
Mailing Address - Country:US
Mailing Address - Phone:978-422-7314
Mailing Address - Fax:
Practice Address - Street 1:32 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-1434
Practice Address - Country:US
Practice Address - Phone:978-422-7314
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA138371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice