Provider Demographics
NPI:1851998827
Name:SALLOUM, RAMI (DMD)
Entity Type:Individual
Prefix:
First Name:RAMI
Middle Name:
Last Name:SALLOUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3348
Mailing Address - Country:US
Mailing Address - Phone:781-899-3700
Mailing Address - Fax:
Practice Address - Street 1:879 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7414
Practice Address - Country:US
Practice Address - Phone:781-899-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist