Healthcare Provider Details

I. General information

NPI: 1073449195
Provider Name (Legal Business Name): OMAR LABABIDI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

IV. Provider business mailing address

8183 LAKE SERENE DR
ORLANDO FL
32836-5021
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: