Provider Demographics
NPI:1609250372
Name:OMAMI, GALAL M (BDS, MSC)
Entity Type:Individual
Prefix:
First Name:GALAL
Middle Name:M
Last Name:OMAMI
Suffix:
Gender:M
Credentials:BDS, MSC
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET, ROOM D104
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-5831
Mailing Address - Fax:859-257-5859
Practice Address - Street 1:800 ROSE ST RM D104
Practice Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-5831
Practice Address - Fax:859-257-5859
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY96221223X0008X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100380020Medicaid