Provider Demographics
NPI:1891960449
Name:LAWRENCE J SALATA DDS INC
Entity Type:Organization
Organization Name:LAWRENCE J SALATA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALATA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-879-0121
Mailing Address - Street 1:8562 NAVARRE RD SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8814
Mailing Address - Country:US
Mailing Address - Phone:330-879-0121
Mailing Address - Fax:
Practice Address - Street 1:8562 NAVARRE RD SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8814
Practice Address - Country:US
Practice Address - Phone:330-879-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19168261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847045330006OtherBCBS
024032OtherUNITED CONCORDIA