Healthcare Provider Details

I. General information

NPI: 1548190093
Provider Name (Legal Business Name): ALAA SALLOUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 FORD RD
DEARBORN MI
48126-2945
US

IV. Provider business mailing address

1516 N JOHN DALY RD
DEARBORN HEIGHTS MI
48127-4904
US

V. Phone/Fax

Practice location:
  • Phone: 313-451-8304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: