Healthcare Provider Details

I. General information

NPI: 1942681317
Provider Name (Legal Business Name): OMAR M DARWISH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 GREAT NORTHERN MALL
NORTH OLMSTED OH
44070-3303
US

IV. Provider business mailing address

5000 GREAT NORTHERN MALL
NORTH OLMSTED OH
44070-3303
US

V. Phone/Fax

Practice location:
  • Phone: 440-734-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberRES3574
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.24838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: