Provider Demographics
NPI:1801955042
Name:SALISBURY, CATHERINE TAMMY (RDH)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:TAMMY
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N 500 W
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5480
Mailing Address - Country:US
Mailing Address - Phone:208-238-5446
Mailing Address - Fax:208-238-5463
Practice Address - Street 1:MISSION RD
Practice Address - Street 2:
Practice Address - City:FORT HALL
Practice Address - State:ID
Practice Address - Zip Code:83203-0717
Practice Address - Country:US
Practice Address - Phone:208-238-5446
Practice Address - Fax:208-238-5463
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH-0814124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist