Provider Demographics
NPI:1164665675
Name:SALAMEH, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SALAMEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9519 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5227
Mailing Address - Country:US
Mailing Address - Phone:615-715-0265
Mailing Address - Fax:
Practice Address - Street 1:9519 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5227
Practice Address - Country:US
Practice Address - Phone:615-715-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist