Provider Demographics
NPI:1851957773
Name:SALEH, MALAKA (DDS)
Entity Type:Individual
Prefix:
First Name:MALAKA
Middle Name:
Last Name:SALEH
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 1:4225 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1529
Mailing Address - Country:US
Mailing Address - Phone:313-381-7770
Mailing Address - Fax:
Practice Address - Street 1:4225 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1529
Practice Address - Country:US
Practice Address - Phone:313-381-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2901600688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program