Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2901600114 | MI |
NPI | 1235783176 |
---|---|
Provider Name | Salah Aldin Rajab |
First Address | Dearborn, MI 48124-2395 |
Second Address | Southfield, MI 48075-2666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |