Provider Demographics
NPI:1649325531
Name:SALZBERG-SIEGEL, MINDY SUE (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:SUE
Last Name:SALZBERG-SIEGEL
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 S GLENHURST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2934
Mailing Address - Country:US
Mailing Address - Phone:248-644-7959
Mailing Address - Fax:
Practice Address - Street 1:38550 GARFIELD RD
Practice Address - Street 2:SUITE C.
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3406
Practice Address - Country:US
Practice Address - Phone:586-416-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0138151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI778716OtherUNITED CONCORDIA PROVIDER