Healthcare Provider Details

I. General information

NPI: 1124097316
Provider Name (Legal Business Name): OMAR SALEM DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N MAIN ST
SHARON MA
02067-1172
US

IV. Provider business mailing address

450 N MAIN ST
SHARON MA
02067-1172
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-6464
  • Fax:
Mailing address:
  • Phone: 781-784-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21358
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: