Provider Demographics
NPI:1043195449
Name:SHABAN, ROGER SALEH (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SALEH
Last Name:SHABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 ELMGROVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ON
Mailing Address - Zip Code:N8N 3S4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38000 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2453
Practice Address - Country:US
Practice Address - Phone:734-591-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010185141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice