Provider Demographics
NPI:1245735166
Name:NIJEM, OMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:NIJEM
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 1:3725 S OCEAN DR APT 1610
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2989
Mailing Address - Country:US
Mailing Address - Phone:845-803-1751
Mailing Address - Fax:
Practice Address - Street 1:1717 N BAYSHORE DR STE 235
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1180
Practice Address - Country:US
Practice Address - Phone:844-393-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060479122300000X
FLDN265551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Multi-Specialty