Provider Demographics
NPI:1891895355
Name:SALINE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SALINE FAMILY DENTISTRY
Other - Org Name:DEARBORN DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFIQ
Authorized Official - Middle Name:PN
Authorized Official - Last Name:BELBEISI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-429-1323
Mailing Address - Street 1:1235 INDUSTRIAL SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176
Mailing Address - Country:US
Mailing Address - Phone:734-429-1323
Mailing Address - Fax:734-429-1332
Practice Address - Street 1:1235 INDUSTRIAL SUITE 2
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176
Practice Address - Country:US
Practice Address - Phone:734-429-1323
Practice Address - Fax:734-429-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID155840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01536648OtherUNITED CONCORDIA
MID801146OtherBCBS
MI2660815Medicaid