Healthcare Provider Details

I. General information

NPI: 1619590114
Provider Name (Legal Business Name): OMAR MAURIZIO ALTIERI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2758 N ROOSEVELT BLVD
KEY WEST FL
33040-3930
US

IV. Provider business mailing address

2758 N ROOSEVELT BLVD
KEY WEST FL
33040-3930
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-9914
  • Fax:
Mailing address:
  • Phone: 305-294-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: