Provider Demographics
NPI:1134891914
Name:OMAR, LORENA (CRDH)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 SE 8TH TER STE A
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3289
Mailing Address - Country:US
Mailing Address - Phone:239-574-2000
Mailing Address - Fax:239-574-1144
Practice Address - Street 1:1435 SE 8TH TER STE A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3289
Practice Address - Country:US
Practice Address - Phone:239-574-2000
Practice Address - Fax:239-574-1144
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH28858124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist