Provider Demographics
NPI:1982855524
Name:MOHAMED, OMAR (DMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:MOHAMED
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 1:12 E. 86TH ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-737-3383
Mailing Address - Fax:212-737-0550
Practice Address - Street 1:12 E. 86TH ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-737-3383
Practice Address - Fax:212-737-0550
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist