Provider Demographics
NPI:1255460945
Name:SALEM, ROBERT MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:SALEM
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 1:75 VAN DEENE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3216
Mailing Address - Country:US
Mailing Address - Phone:413-739-7125
Mailing Address - Fax:413-737-1718
Practice Address - Street 1:75 VAN DEENE AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3216
Practice Address - Country:US
Practice Address - Phone:413-739-7125
Practice Address - Fax:413-737-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice