Provider Demographics
NPI:1730641341
Name:ALMAKKY, OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ALMAKKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 CHANCERY PL
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8766
Mailing Address - Country:US
Mailing Address - Phone:937-823-0205
Mailing Address - Fax:
Practice Address - Street 1:11319 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4201
Practice Address - Country:US
Practice Address - Phone:513-873-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357882Medicaid