Provider Demographics
NPI:1205922267
Name:SALISBURY, STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
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 1:1446 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8038
Mailing Address - Country:US
Mailing Address - Phone:503-665-7600
Mailing Address - Fax:503-492-0224
Practice Address - Street 1:1446 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8038
Practice Address - Country:US
Practice Address - Phone:503-665-7600
Practice Address - Fax:503-492-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR49741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR183368Medicaid