Provider Demographics
NPI:1679795223
Name:DR JEFFREY IAN SALTZ DDS, PA
Entity Type:Organization
Organization Name:DR JEFFREY IAN SALTZ DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:SALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-439-5413
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:207-439-5167
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:207-439-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME32571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty