Provider Demographics
NPI:1881668929
Name:SALIN, MICHAEL BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:SALIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W STREET RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4168
Mailing Address - Country:US
Mailing Address - Phone:215-322-7810
Mailing Address - Fax:215-322-7832
Practice Address - Street 1:137 W STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053-4168
Practice Address - Country:US
Practice Address - Phone:215-322-7810
Practice Address - Fax:215-322-7832
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030984L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2293622000OtherKEYSTONE
PA1615888OtherBLUE SHIELD
PA2293622000OtherKEYSTONE
PA084162Medicare ID - Type Unspecified