MEDICARE: DR. SALAM OMAR SALMAN M.D., D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DTP618	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8715	KY
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	ME124338	FL
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN123170	GA

General Provider Information

NPI Number	:	1154555035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALAM OMAR SALMAN M.D., D.D.S

Provider Business Mailing Address
First Line	:	117 PROFESSIONAL CT SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-7036
Country	:	US
Telephone Number	:	706-629-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 PROFESSIONAL CT SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-7036
Country	:	US
Telephone Number	:	706-629-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	02/20/2024

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