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General NPI Number Information
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NPI Number | 1780390914
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Entity Type | Individual
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Provider Name | MAMDOUH OMAR KACHLAN DMD, MS, FACP
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Gender | Male
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2700 S TAMIAMI TRL STE 8
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City | SARASOTA
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State | FL
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Zip | 34239-4528
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Country | US
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Telephone | 941-951-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 13810 MESSINA LOOP UNIT 101
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City | BRADENTON
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State | FL
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Zip | 34211-2239
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Country | US
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Telephone | 267-401-8885
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DS043096
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN29788
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License Number State | FL
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