Provider Demographics
NPI:1558887232
Name:OMAR, AMIRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HARBOR POINT BLVD APT 407
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3205
Mailing Address - Country:US
Mailing Address - Phone:917-870-7297
Mailing Address - Fax:
Practice Address - Street 1:137 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1304
Practice Address - Country:US
Practice Address - Phone:774-425-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858838122300000X, 1223G0001X
MADL13339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentist