Provider Demographics
NPI:1790271195
Name:ELNABAWI, OMAR (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ELNABAWI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BROAD ST STE 1530
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1026
Mailing Address - Country:US
Mailing Address - Phone:215-383-9800
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST STE 1530
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1026
Practice Address - Country:US
Practice Address - Phone:215-383-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0419301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics