Provider Demographics
NPI:1861688913
Name:SALLAN, RAY AMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:AMER
Last Name:SALLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NORTHWICK CT.
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:954-732-1136
Mailing Address - Fax:
Practice Address - Street 1:2360 EAST STADIUM BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-677-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist