Provider Demographics
NPI:1770647398
Name:ALWAKFI, OMAR M (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:M
Last Name:ALWAKFI
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:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:RICHMONDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12149-0492
Mailing Address - Country:US
Mailing Address - Phone:518-294-6015
Mailing Address - Fax:518-294-6017
Practice Address - Street 1:303 MAIN ST #1
Practice Address - Street 2:
Practice Address - City:RICHMONDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12149-2603
Practice Address - Country:US
Practice Address - Phone:518-294-6015
Practice Address - Fax:518-294-6017
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046831OtherNEW YORK STATE LICENSE NU