MEDICARE: DR. ANISA OMAR 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN1000746	DC

General Provider Information

NPI Number	:	1730332636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANISA OMAR DDS

Provider Business Mailing Address
First Line	:	4434 MACARTHUR BLVD NW
Second Line	:	SUITE # 201
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2550
Country	:	US
Telephone Number	:	202-333-3883
Fax Number	:	202-333-3881

Provider Business Practice Location Address
First Line	:	4434 MACARTHUR BLVD NW
Second Line	:	SUITE # 201
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2550
Country	:	US
Telephone Number	:	202-333-3883
Fax Number	:	202-333-3881

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

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/23/2008

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