MEDICARE: OMAR ANSARI DDS

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	122300000X	Dentist	2901020901	MI

General Provider Information

NPI Number	:	1619316064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR ANSARI DDS

Provider Business Mailing Address
First Line	:	28282 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-5604
Country	:	US
Telephone Number	:	586-574-2620
Fax Number	:	586-574-3015

Provider Business Practice Location Address
First Line	:	3962 ROCHESTER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-5248
Country	:	US
Telephone Number	:	248-429-5555
Fax Number	:	248-494-4944

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	03/18/2026

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