Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000003572 | TN |
NPI | 1578533915 |
---|---|
Provider Name | Dr. Ronald James Salage |
First Address | Clinton, TN 37716 |
Second Address | Clinton, TN 37716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |