Provider Demographics
NPI:1336413632
Name:SALEM FAMILY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:SALEM FAMILY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:WON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-744-1211
Mailing Address - Street 1:10 FEDERAL ST STE 16
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3875
Mailing Address - Country:US
Mailing Address - Phone:978-744-1211
Mailing Address - Fax:978-744-1205
Practice Address - Street 1:10 FEDERAL ST STE 16
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3875
Practice Address - Country:US
Practice Address - Phone:978-744-1211
Practice Address - Fax:978-744-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty