Healthcare Provider Details

I. General information

NPI: 1548418460
Provider Name (Legal Business Name): OMAR SALEM, DMD, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
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: 781-784-4148
Mailing address:
  • Phone: 781-784-6464
  • Fax: 781-784-4148

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: DR. OMAR SALEM
Title or Position: OWNER/PRESIDENT
Credential: DMD, MSD
Phone: 781-784-6464