=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912662149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMAR ALMAKKY, DMD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2021
-----------------------------------------------------
Last Update Date | 11/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11319 SPRINGFIELD PIKE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-823-0205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5708 CHANCERY PL
-----------------------------------------------------
City | LIBERTY TWP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45011-8766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-823-0205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. OMAR ALMAKKY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 937-823-0205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------