Provider Demographics
NPI:1427628585
Name:ASFOUR, OMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ASFOUR
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 1:1564 WIND ENERGY PASS
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-8929
Mailing Address - Country:US
Mailing Address - Phone:856-505-7301
Mailing Address - Fax:
Practice Address - Street 1:495 ROUTE 47 STE J
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-8020
Practice Address - Country:US
Practice Address - Phone:856-505-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist