Provider Demographics
NPI:1700958808
Name:MACARAEG, OMAR A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:MACARAEG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:A
Other - Last Name:MACARAEG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8068
Mailing Address - Country:US
Mailing Address - Phone:303-795-9699
Mailing Address - Fax:303-795-9697
Practice Address - Street 1:2 W DRY CREEK CIR
Practice Address - Street 2:SUITE 170
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8068
Practice Address - Country:US
Practice Address - Phone:303-795-9699
Practice Address - Fax:303-795-9697
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics