Provider Demographics
NPI:1366534356
Name:SARLAK, AMIR SALAR (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:SALAR
Last Name:SARLAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:STE E110
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3796
Mailing Address - Country:US
Mailing Address - Phone:410-750-1022
Mailing Address - Fax:410-750-1006
Practice Address - Street 1:5667 COLUMBIA RD
Practice Address - Street 2:APT. 403
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1976
Practice Address - Country:US
Practice Address - Phone:443-545-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist