Provider Demographics
NPI:1841874526
Name:OMS DENTAL LLC
Entity type:Organization
Organization Name:OMS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-344-0453
Mailing Address - Street 1:3420 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4433
Mailing Address - Country:US
Mailing Address - Phone:815-344-0453
Mailing Address - Fax:
Practice Address - Street 1:3420 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4433
Practice Address - Country:US
Practice Address - Phone:815-344-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental