Provider Demographics
NPI:1497781850
Name:MAHMASSANI, OMAR K (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:K
Last Name:MAHMASSANI
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 1:5910 FREDERICK CROSSING LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5112
Mailing Address - Country:US
Mailing Address - Phone:301-662-4422
Mailing Address - Fax:301-965-8360
Practice Address - Street 1:5910 FREDERICK CROSSING LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5112
Practice Address - Country:US
Practice Address - Phone:301-662-4422
Practice Address - Fax:301-965-8360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7585880001Medicare NSC