Provider Demographics
NPI:1124644604
Name:ALSWAITI, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ALSWAITI
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 1:2252 SAGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6162
Mailing Address - Country:US
Mailing Address - Phone:253-318-4997
Mailing Address - Fax:
Practice Address - Street 1:1129 GREEN OAKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1501
Practice Address - Country:US
Practice Address - Phone:253-318-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12797390200000X
TX39920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program