Provider Demographics
NPI:1205351699
Name:SALTZ, ADAM (DMD, MS, MPH)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SALTZ
Suffix:
Gender:M
Credentials:DMD, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2410
Mailing Address - Country:US
Mailing Address - Phone:207-774-5527
Mailing Address - Fax:207-780-1188
Practice Address - Street 1:254 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2410
Practice Address - Country:US
Practice Address - Phone:207-774-5527
Practice Address - Fax:207-780-1188
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN48241223P0300X
FLDN228691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics