Provider Demographics
NPI:1609446616
Name:OMAR, BUSHRA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BUSHRA
Middle Name:M
Last Name:OMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 CITY CENTRE DR UNIT STE400
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6674
Mailing Address - Country:US
Mailing Address - Phone:720-845-6636
Mailing Address - Fax:
Practice Address - Street 1:4275 CITY CENTRE DR UNIT 400
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6678
Practice Address - Country:US
Practice Address - Phone:720-845-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002049911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice