Provider Demographics
NPI:1720517105
Name:SALISBURY, IAN JEFFREY (DMD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:JEFFREY
Last Name:SALISBURY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 SKYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6247
Mailing Address - Country:US
Mailing Address - Phone:541-521-5733
Mailing Address - Fax:
Practice Address - Street 1:2457 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6460
Practice Address - Country:US
Practice Address - Phone:541-521-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist