Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901021793 | MI |
N | 1223G0001X | General Practice | DN014742 | GA |
N | 213EG0000X | General Practice | DN014742 | GA |
NPI | 1629497631 |
---|---|
Provider Name | Maritza Iamalette Salvo-Ale |
First Address | Niles, MI 49120-2281 |
Second Address | Niles, MI 49120-2281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 26/10/2016 |