Provider Demographics
NPI:1629497631
Name:SALVO-ALE, MARITZA IAMALETTE (DDS)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:IAMALETTE
Last Name:SALVO-ALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:IAMALETTE
Other - Last Name:SALVO REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:122 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2281
Mailing Address - Country:US
Mailing Address - Phone:269-262-4364
Mailing Address - Fax:269-340-5981
Practice Address - Street 1:122 GRANT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2281
Practice Address - Country:US
Practice Address - Phone:269-262-4364
Practice Address - Fax:269-340-5981
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0147421223G0001X
MI29010217931223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice