Individual provider Active NPI

Krystal Thalia Salhuana, DDS

  • General Practice Dentistry
  • Taylor, MI
National Provider Identifier
1790412740
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901601466 Issued in MI
Practice address
25850 Eureka Rd
Taylor, MI 48180-4924
Phone
(734) 992-8688
NPI assigned
Aug 1, 2022
Reactivated
Nov 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901601466 MI Primary

Addresses

Primary practice location

25850 Eureka Rd
Taylor, MI 48180-4924

Mailing address

1547 W Saratoga St
Ferndale, MI 48220-1659
Phone (954) 290-6807

Other practice location 1

49175 Pontiac Trl
Wixom, MI 48393-2580
Phone (248) 859-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2901601466MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ez Dentists PLC PastSince Aug 1, 2022 Accepting new patients
Wixom Dental PastSince Apr 10, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1790412740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 W SARATOGA ST",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201659",
            "telephone_number": "954-290-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25850 EUREKA RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804924",
            "telephone_number": "734-992-8688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "49175 Pontiac Trl",
            "address_purpose": "LOCATION",
            "city": "Wixom",
            "state": "MI",
            "postal_code": "483932580",
            "country_code": "US",
            "telephone_number": "248-859-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SALHUANA",
        "first_name": "KRYSTAL",
        "middle_name": "THALIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "deactivation_date": "2022-09-22",
        "reactivation_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.