Provider Demographics
NPI:1801467535
Name:ABDEL-RAHIM, OMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ABDEL-RAHIM
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 1:542 SOMBRILLO
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1441
Mailing Address - Country:US
Mailing Address - Phone:805-574-0044
Mailing Address - Fax:
Practice Address - Street 1:5075 S BRADLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5077
Practice Address - Country:US
Practice Address - Phone:805-934-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1064591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice