MEDICARE: DR. OMAR ELNABAWI DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS041930	PA

General Provider Information

NPI Number	:	1790271195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR ELNABAWI DMD, MS

Provider Business Mailing Address
First Line	:	100 S BROAD ST STE 1530
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19110-1026
Country	:	US
Telephone Number	:	215-383-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S BROAD ST STE 1530
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19110-1026
Country	:	US
Telephone Number	:	215-383-9800
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	09/10/2018

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