Provider Demographics
NPI:1700299633
Name:MONROEPERIODONTICS PLLC
Entity Type:Organization
Organization Name:MONROEPERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTITS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SALESIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-682-5411
Mailing Address - Street 1:120 COLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4104
Mailing Address - Country:US
Mailing Address - Phone:734-682-5411
Mailing Address - Fax:734-682-5448
Practice Address - Street 1:120 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-682-5411
Practice Address - Fax:734-682-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty