Provider Demographics
NPI:1144841701
Name:PANOL, OMAR ALEJANDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ALEJANDRO
Last Name:PANOL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14037 NW 88TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7343
Mailing Address - Country:US
Mailing Address - Phone:305-900-0873
Mailing Address - Fax:
Practice Address - Street 1:30 ACME ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3306
Practice Address - Country:US
Practice Address - Phone:740-373-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL273741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program