MEDICARE: DR. OMAR M DARWISH 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	1223G0001X	General Practice Dentistry	30.24838	OH
2	122300000X	Dentist	RES3574	OH

General Provider Information

NPI Number	:	1942681317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR M DARWISH DMD

Provider Business Mailing Address
First Line	:	5000 GREAT NORTHERN MALL
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 GREAT NORTHERN MALL
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3303
Country	:	US
Telephone Number	:	440-734-6500
Fax Number	:

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/27/2016

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