Provider Demographics
NPI:1053838441
Name:INTEGRATED HEALTH CHOICES ROSEVILLE PC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CHOICES ROSEVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-775-3312
Mailing Address - Street 1:25631 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-775-3312
Mailing Address - Fax:586-775-4780
Practice Address - Street 1:25631 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-775-3312
Practice Address - Fax:586-775-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty