Provider Demographics
NPI:1124097316
Name:SALEM, OMAR (DMD, MS)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SALEM
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1172
Mailing Address - Country:US
Mailing Address - Phone:781-784-6464
Mailing Address - Fax:
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1172
Practice Address - Country:US
Practice Address - Phone:781-784-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX09203OtherBCBS - DENTAL