MEDICARE: DR. OMAR K MAHMASSANI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	10913	MD
2	122300000X	Dentist	10913	MD

General Provider Information

NPI Number	:	1497781850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR K MAHMASSANI D.D.S.

Provider Business Mailing Address
First Line	:	5910 FREDERICK CROSSING LN
Second Line	:	SUITE 101
City	:	FREDERICK
State	:	MD
Zip	:	21704-5112
Country	:	US
Telephone Number	:	301-662-4422
Fax Number	:	301-965-8360

Provider Business Practice Location Address
First Line	:	5910 FREDERICK CROSSING LN
Second Line	:	SUITE 101
City	:	FREDERICK
State	:	MD
Zip	:	21704-5112
Country	:	US
Telephone Number	:	301-662-4422
Fax Number	:	301-965-8360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	04/28/2026

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