Provider Demographics
NPI:1639500242
Name:SATTOUT, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SATTOUT
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 1:1124 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1939
Mailing Address - Country:US
Mailing Address - Phone:909-248-8417
Mailing Address - Fax:
Practice Address - Street 1:1020 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1536
Practice Address - Country:US
Practice Address - Phone:909-248-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist