Healthcare Provider Details

I. General information

NPI: 1356029672
Provider Name (Legal Business Name): OMAR SALAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 FENTON ST STE 100
SILVER SPRING MD
20910-4753
US

IV. Provider business mailing address

415 COUNCIL DR NE
VIENNA VA
22180-4740
US

V. Phone/Fax

Practice location:
  • Phone: 301-608-9800
  • Fax:
Mailing address:
  • Phone: 503-707-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18298
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: