MEDICARE: DR. ANNIE M AMSALEM DDS

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	1223P0300X	Periodontics	14104	MA

General Provider Information

NPI Number	:	1497775050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE M AMSALEM DDS

Provider Business Mailing Address
First Line	:	22 MILL ST STE 104
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4738
Country	:	US
Telephone Number	:	781-648-0279
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 MILL ST STE 104
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4738
Country	:	US
Telephone Number	:	781-648-0279
Fax Number	:	781-641-3143

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/18/2021

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