Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 045422-1 | NY |
N | 1223P0300X | Periodontist | 19260 | MA |
NPI | 1063541936 |
---|---|
Provider Name | Dr. Salomon Amar |
First Address | Brookline, MA 02446-2917 |
Second Address | Brookline, MA 02446-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 03/10/2017 |