Provider Demographics
NPI:1841424496
Name:OMRAN, MONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:OMRAN
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 1:1075 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3242
Mailing Address - Country:US
Mailing Address - Phone:856-906-1578
Mailing Address - Fax:
Practice Address - Street 1:1075 CENTRAL PARK AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-472-9400
Practice Address - Fax:914-723-1160
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101311223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008014133Medicaid