MEDICARE: OMEIR TARIQ 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	24485	FL

General Provider Information

NPI Number	:	1891337366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMEIR TARIQ ANSARI DDS

Provider Business Mailing Address
First Line	:	5305 HAWK DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746
Country	:	US
Telephone Number	:	407-749-9656
Fax Number	:

Provider Business Practice Location Address
First Line	:	3779 LAKE EMMA RD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6156
Country	:	US
Telephone Number	:	407-547-1359
Fax Number	:

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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