Healthcare Provider Details

I. General information

NPI: 1245816339
Provider Name (Legal Business Name): TABITHA SALAM NAIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8127 GRAND RIVER RD
BRIGHTON MI
48114-9375
US

IV. Provider business mailing address

2496 SILVERSIDE RD
WATERFORD MI
48328-1782
US

V. Phone/Fax

Practice location:
  • Phone: 248-685-7273
  • Fax:
Mailing address:
  • Phone: 248-860-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601469
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2951000844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: