Provider Demographics
NPI:1356525794
Name:OMAR, ABDULKAWI M (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDULKAWI
Middle Name:M
Last Name:OMAR
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E STERNBERG RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7880
Mailing Address - Country:US
Mailing Address - Phone:231-799-8100
Mailing Address - Fax:
Practice Address - Street 1:15846 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2905
Practice Address - Country:US
Practice Address - Phone:313-581-1864
Practice Address - Fax:313-581-1646
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195541223G0001X
MI2901011514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist