Provider Demographics
NPI:1437253911
Name:AYERS-SALLOWS, NANCY J (DDS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:AYERS-SALLOWS
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 1:212 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9735
Mailing Address - Country:US
Mailing Address - Phone:517-759-0882
Mailing Address - Fax:896-300-7679
Practice Address - Street 1:815 N CLARE AVE STE C
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-8177
Practice Address - Country:US
Practice Address - Phone:989-630-0760
Practice Address - Fax:989-630-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3443080OtherTIN NUMBER