Provider Demographics
NPI:1396024220
Name:OMAR SOUMAN, DMD, P.C.
Entity Type:Organization
Organization Name:OMAR SOUMAN, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-283-4350
Mailing Address - Street 1:6301 CERMAK RD STE B
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2368
Mailing Address - Country:US
Mailing Address - Phone:708-956-7516
Mailing Address - Fax:
Practice Address - Street 1:6301 CERMAK RD STE B
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2368
Practice Address - Country:US
Practice Address - Phone:708-956-7516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028602261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental