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General NPI Number Information
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NPI Number | 1629643838
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Entity Type | Individual
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Provider Name | ADNAN QASIM OMRAN DMD
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Gender | Male
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 1725 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1862
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Country | US
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Telephone | 231-237-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 3580 WESTHAMPTON CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1413
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Country | US
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Telephone | 313-808-0702
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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 |
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License Number State | LA
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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 | 2901601000
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License Number State | MI
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