Healthcare Provider Details

I. General information

NPI: 1023105848
Provider Name (Legal Business Name): OMAR GUESMIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 E COLLEGE AVE
RUSKIN FL
33570-5220
US

IV. Provider business mailing address

3070 E COLLEGE AVE
RUSKIN FL
33570-5220
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-2945
  • Fax:
Mailing address:
  • Phone: 813-641-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32459
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050409-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: