Provider Demographics
NPI:1144756792
Name:ALHMOUD, OMAR (DDS)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ALHMOUD
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 1:9519 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5227
Mailing Address - Country:US
Mailing Address - Phone:330-423-6779
Mailing Address - Fax:330-548-9489
Practice Address - Street 1:9519 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5227
Practice Address - Country:US
Practice Address - Phone:330-423-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025978122300000X
IN12012674A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist