Provider Demographics
NPI:1114692381
Name:AKILEH, OMAR AIMAN (DMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:AIMAN
Last Name:AKILEH
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 1:3280 SW 170TH AVE APT 2209
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8614
Mailing Address - Country:US
Mailing Address - Phone:407-592-1116
Mailing Address - Fax:
Practice Address - Street 1:215 CURTIS AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1619
Practice Address - Country:US
Practice Address - Phone:541-837-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD115411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice