Provider Demographics
NPI:1871686402
Name:SHARIFF, OMAR MOHAMMED (DDS)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:MOHAMMED
Last Name:SHARIFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BRIARVISTA WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3629
Mailing Address - Country:US
Mailing Address - Phone:502-974-6494
Mailing Address - Fax:
Practice Address - Street 1:1040 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9072
Practice Address - Country:US
Practice Address - Phone:678-466-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010874A1223G0001X
KY84471223G0001X
GADN0148951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice