Provider Demographics
NPI:1023371945
Name:YOUSUF, OMAR MOHAMMED (DDS)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:MOHAMMED
Last Name:YOUSUF
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 1:5940 W PARKER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6404
Mailing Address - Country:US
Mailing Address - Phone:214-619-6329
Mailing Address - Fax:
Practice Address - Street 1:5940 W PARKER RD STE 103
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6404
Practice Address - Country:US
Practice Address - Phone:214-619-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62921223G0001X
TX278981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice