Provider Demographics
NPI:1487386561
Name:AOGHIZ, SALLEN (DDS)
Entity type:Individual
Prefix:
First Name:SALLEN
Middle Name:
Last Name:AOGHIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 CLARKSON DR APT 12
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-5251
Mailing Address - Country:US
Mailing Address - Phone:586-277-7859
Mailing Address - Fax:
Practice Address - Street 1:19931 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2591
Practice Address - Country:US
Practice Address - Phone:248-274-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist