MEDICARE: OMAR FEDERICO TAPIA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	112666	CA

General Provider Information

NPI Number	:	1043165160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR FEDERICO TAPIA DDS

Provider Business Mailing Address
First Line	:	4869 ROYAL ISLAND WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-8516
Country	:	US
Telephone Number	:	619-207-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 FOURTH AVE STE 16
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3896
Country	:	US
Telephone Number	:	619-420-1144
Fax Number	:	619-420-2373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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