Provider Demographics
NPI:1629212113
Name:SALISBURY & DRISCOLL, D.D.S., P.A.
Entity Type:Organization
Organization Name:SALISBURY & DRISCOLL, D.D.S., P.A.
Other - Org Name:ENLIGHTEN DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-765-0904
Mailing Address - Street 1:1551 WESTBROOK PLAZA DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1355
Mailing Address - Country:US
Mailing Address - Phone:336-765-0904
Mailing Address - Fax:336-765-3422
Practice Address - Street 1:1551 WESTBROOK PLAZA DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1355
Practice Address - Country:US
Practice Address - Phone:336-765-0904
Practice Address - Fax:336-765-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2679261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental