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General NPI Number Information
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NPI Number | 1124644604
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Entity Type | Individual
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Provider Name | OMAR ALSWAITI
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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 | 08/22/2023
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Provider Practice Location Address
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Address Line | 1129 GREEN OAKS RD
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City | FORT WORTH
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State | TX
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Zip | 76116-1501
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Country | US
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Telephone | 253-318-4997
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Fax |
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Provider Business Mailing Address
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Address Line | 2252 SAGE HILL LN
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City | COPPELL
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State | TX
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Zip | 75019-6162
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Country | US
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Telephone | 253-318-4997
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 12797
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License Number State | CT
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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 | 39920
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License Number State | TX
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