Provider Demographics
NPI:1386013118
Name:EL-KWEIFI, OMAR (DDS)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:EL-KWEIFI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:
Other - Last Name:E.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4900 MEDICAL DR
Mailing Address - Street 2:APT #1718
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5389
Mailing Address - Country:US
Mailing Address - Phone:832-859-8328
Mailing Address - Fax:
Practice Address - Street 1:1809 LOUISE LN
Practice Address - Street 2:200
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-1500
Practice Address - Country:US
Practice Address - Phone:830-505-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice