Healthcare Provider Details

I. General information

NPI: 1992549935
Provider Name (Legal Business Name): SAMARA OLIVEIRA AOUN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ESSEX ST
LAWRENCE MA
01840-1410
US

IV. Provider business mailing address

14 KENSINGTON PARK APT 5
LYNN MA
01902-3370
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN10000339
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: