Provider Demographics
NPI:1609979012
Name:SALTZ, JEFFREY IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:IAN
Last Name:SALTZ
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 1:74 STATE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1564
Mailing Address - Country:US
Mailing Address - Phone:207-439-5413
Mailing Address - Fax:
Practice Address - Street 1:74 STATE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1564
Practice Address - Country:US
Practice Address - Phone:207-439-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME32571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics