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General NPI Number Information
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NPI Number | 1013334291
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Entity Type | Individual
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Provider Name | OMAR MAZEN MAKTABI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 12/06/2015
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Provider Practice Location Address
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Address Line | 2814 NORTHGATE DR STE 1 ENDODONTIC ASSOCIATES OF IOWA
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City | IOWA CITY
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State | IA
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Zip | 52245-9513
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Country | US
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Telephone | 319-351-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 845 QUARRY RD #214
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City | CORALVILLE
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State | IA
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Zip | 52241-2212
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Country | US
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Telephone | 909-219-2535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63245
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09255
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License Number State | IA
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