Provider Demographics
NPI:1861666992
Name:DR. DONALD H. SALTZMAN, D.D.S., P.C.
Entity Type:Organization
Organization Name:DR. DONALD H. SALTZMAN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-491-0660
Mailing Address - Street 1:1029 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3877
Mailing Address - Country:US
Mailing Address - Phone:847-492-0660
Mailing Address - Fax:847-869-5858
Practice Address - Street 1:1029 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3877
Practice Address - Country:US
Practice Address - Phone:847-492-0660
Practice Address - Fax:847-869-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-011974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-011974Medicaid