Healthcare Provider Details

I. General information

NPI: 1053937086
Provider Name (Legal Business Name): OMAR ABDELRAHMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51685 VAN DYKE AVE
SHELBY TOWNSHIP MI
48316-4449
US

IV. Provider business mailing address

51685 VAN DYKE AVE
SHELBY TOWNSHIP MI
48316-4449
US

V. Phone/Fax

Practice location:
  • Phone: 586-924-2038
  • Fax:
Mailing address:
  • Phone: 586-924-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901601045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: