Provider Demographics
NPI:1992289938
Name:OMAR, DUAA AHMAD (DDS)
Entity type:Individual
Prefix:
First Name:DUAA
Middle Name:AHMAD
Last Name:OMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 SW WILSHIRE BLVD STE 101A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8727
Mailing Address - Country:US
Mailing Address - Phone:817-426-0300
Mailing Address - Fax:
Practice Address - Street 1:1055 SW WILSHIRE BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8727
Practice Address - Country:US
Practice Address - Phone:682-560-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist