Provider Demographics
NPI:1104875657
Name:SALEM, SAMUEL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JOHN
Last Name:SALEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1395
Mailing Address - Country:US
Mailing Address - Phone:810-733-2750
Mailing Address - Fax:810-733-3234
Practice Address - Street 1:5103 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-1395
Practice Address - Country:US
Practice Address - Phone:810-733-2750
Practice Address - Fax:810-733-3234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist