Healthcare Provider Details

I. General information

NPI: 1407510332
Provider Name (Legal Business Name): NW ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 3 MILE RD NW STE 102
GRAND RAPIDS MI
49544-1673
US

IV. Provider business mailing address

933 3 MILE RD NW STE 102
GRAND RAPIDS MI
49544-1673
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-5993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EMAN SALALMEH
Title or Position: OWNER
Credential: DDS
Phone: 313-282-4187