Provider Demographics
NPI:1255691051
Name:ABDEL-SALAM, ASMAA FATHALLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASMAA
Middle Name:FATHALLA
Last Name:ABDEL-SALAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 CHOVIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3003
Mailing Address - Country:US
Mailing Address - Phone:313-467-2158
Mailing Address - Fax:
Practice Address - Street 1:23239 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2029
Practice Address - Country:US
Practice Address - Phone:313-561-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice