Provider Demographics
NPI:1578868709
Name:HERB G. SALISBURY, PA
Entity Type:Organization
Organization Name:HERB G. SALISBURY, PA
Other - Org Name:PANAMA CITY DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERB
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-784-0700
Mailing Address - Street 1:2410 SAINT ANDREWS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2134
Mailing Address - Country:US
Mailing Address - Phone:850-784-0700
Mailing Address - Fax:850-784-0903
Practice Address - Street 1:2410 SAINT ANDREWS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2134
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:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1396810024OtherPERSONAL NPI