Provider Demographics
NPI:1972200335
Name:EL ESSAWY, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:EL ESSAWY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14051 NEWPORT AVE STE F
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5171
Mailing Address - Country:US
Mailing Address - Phone:714-310-9896
Mailing Address - Fax:
Practice Address - Street 1:14051 NEWPORT AVE STE F
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5171
Practice Address - Country:US
Practice Address - Phone:714-310-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1077071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice