Provider Demographics
NPI:1962070417
Name:OMARI, MUHAMMAD ABDALLA (DDS)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:ABDALLA
Last Name:OMARI
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 1:1710 N COMMERCE ST APT 212
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-4037
Mailing Address - Country:US
Mailing Address - Phone:262-323-3443
Mailing Address - Fax:
Practice Address - Street 1:1710 N COMMERCE ST APT 212
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-4037
Practice Address - Country:US
Practice Address - Phone:262-323-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014174361223G0001X
IL019.0333651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice