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General NPI Number Information
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NPI Number | 1255768578
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Entity Type | Individual
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Provider Name | OMAR CLOR D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 655 SOUTH 7TH STREET BLDG 700/700-A 78 MDG/SGHC
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City | ROBINS AFB
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State | GA
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Zip | 31098
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Country | US
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Telephone | 478-497-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 307 CHARLOTTE DR
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City | BONAIRE
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State | GA
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Zip | 31005-4922
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Country | US
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Telephone | 515-771-0426
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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 | 019.029654
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License Number State | IL
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