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General NPI Number Information
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NPI Number | 1063038461
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Entity Type | Individual
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Provider Name | OMER MOHAMED ALI IBRAHIM BDS, DDS
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 401 S GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38801-5540
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Country | US
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Telephone | 662-346-5906
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Fax |
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Provider Business Mailing Address
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Address Line | 4071 LEE RD STE 260
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City | CLEVELAND
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State | OH
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Zip | 44128-2173
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Country | US
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Telephone | 216-534-8616
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 111696
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License Number State | MS
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