Provider Demographics
NPI:1477142347
Name:ALKHALIDI, OMEED
Entity Type:Individual
Prefix:
First Name:OMEED
Middle Name:
Last Name:ALKHALIDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 E MISSISSIPPI AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6832
Mailing Address - Country:US
Mailing Address - Phone:916-494-4612
Mailing Address - Fax:
Practice Address - Street 1:9201 E MISSISSIPPI AVE APT 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6832
Practice Address - Country:US
Practice Address - Phone:916-494-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002046211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice