Provider Demographics
NPI:1124357751
Name:MUBARAK, OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:MUBARAK
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 1:38029 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1384
Mailing Address - Country:US
Mailing Address - Phone:813-783-1119
Mailing Address - Fax:
Practice Address - Street 1:6350 PALM TRACE LANDINGS DR
Practice Address - Street 2:APT #203
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1838
Practice Address - Country:US
Practice Address - Phone:770-826-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist