Provider Demographics
NPI:1790412740
Name:SALHUANA, KRYSTAL THALIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:THALIA
Last Name:SALHUANA
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 1:1547 W SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1659
Mailing Address - Country:US
Mailing Address - Phone:954-290-6807
Mailing Address - Fax:
Practice Address - Street 1:25850 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4924
Practice Address - Country:US
Practice Address - Phone:734-992-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2023-03-15
Deactivation Date:2022-09-22
Deactivation Code:
Reactivation Date:2022-11-01
Provider Licenses
StateLicense IDTaxonomies
MI29016014661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice