NPIMap

Organization Active NPI

Elliot W Salloway DMD Inc

  • Periodontics
  • Worcester, MA
National Provider Identifier
1164440517
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
9215 Issued in MA
Legal business name
ELLIOT W SALLOWAY DMD INC
Practice address
111 Elm St
Ste 203
Worcester, MA 01609
Phone
(508) 752-1302
Fax
(508) 753-5801
NPI assigned
Jul 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Elliot W Salloway, DMD
Title
President Treasurer
Phone
(508) 752-1302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 9215 MA Primary

Addresses

Primary practice location

111 Elm St
Ste 203
Worcester, MA 01609

Mailing address

111 Elm St
Ste 203
Worcester, MA 01609
Phone (508) 752-1302

Other identifiers 2

IdentifierTypeStateIssuer
000608OtherMADELTA DENTAL OF MA
10444OtherMABCBS MA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164440517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ELM ST",
            "address_2": "STE 203",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01609",
            "telephone_number": "508-752-1302",
            "fax_number": "508-753-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ELM ST",
            "address_2": "STE 203",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01609",
            "telephone_number": "508-752-1302",
            "fax_number": "508-753-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOT W SALLOWAY DMD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SALLOWAY",
        "authorized_official_first_name": "ELLIOT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT TREASURER",
        "authorized_official_telephone_number": "508-752-1302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "9215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF MA",
            "identifier": "000608",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "10444",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.