Provider Demographics
NPI:1134286701
Name:OMAR, SORAYA (DDS)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 N LA BREA
Mailing Address - Street 2:SUITE # 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-882-6387
Mailing Address - Fax:323-661-5466
Practice Address - Street 1:1523 N LA BREA
Practice Address - Street 2:SUITE # 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-882-6387
Practice Address - Fax:323-661-5466
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice