Healthcare Provider Details

I. General information

NPI: 1366987638
Provider Name (Legal Business Name): ALL ABOUT SMILES ROSEVILLE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25631 GRATIOT AVE
ROSEVILLE MI
48066-4434
US

IV. Provider business mailing address

25631 GRATIOT AVE
ROSEVILLE MI
48066-4434
US

V. Phone/Fax

Practice location:
  • Phone: 586-775-3312
  • Fax:
Mailing address:
  • Phone: 586-775-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901018508
License Number StateMI

VIII. Authorized Official

Name: DR. MARC H SALAH
Title or Position: DOCTOR
Credential: DDS
Phone: 734-981-1199