MEDICARE: OMAR ABOOSI DMD

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	DS036598	PA

General Provider Information

NPI Number	:	1730243429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR ABOOSI DMD

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:	315-454-8650

Provider Business Practice Location Address
First Line	:	4815 CENTRE AVE
Second Line	:	SUITE 105
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-1705
Country	:	US
Telephone Number	:	412-578-9722
Fax Number	:	412-578-9724

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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