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General NPI Number Information
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NPI Number | 1700299633
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Entity Type | Organization
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Legal Business Name | MONROEPERIODONTICS PLLC
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 120 COLE RD
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-682-5411
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Fax | 734-682-5448
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Provider Business Mailing Address
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Address Line | 120 COLE RD
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City | MONROE
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State | MI
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Zip | 48162-4104
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Country | US
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Telephone | 734-682-5411
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Fax | 734-682-5448
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Authorized Official
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Title or Position | PERIODONTITS
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Name | DR. BRIAN W SALESIN
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Credential | DDS
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Telephone | 734-682-5411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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