Provider Demographics
NPI:1366004285
Name:OMER, YASMIN (DDS)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:OMER
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 1:1168 FIFIELD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1170
Mailing Address - Country:US
Mailing Address - Phone:507-369-8214
Mailing Address - Fax:
Practice Address - Street 1:4080 W BROADWAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5607
Practice Address - Country:US
Practice Address - Phone:443-759-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist