Provider Demographics
NPI:1396397634
Name:ALBASHA, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ALBASHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 BELLAIRE DR S STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5900
Mailing Address - Country:US
Mailing Address - Phone:551-214-4133
Mailing Address - Fax:
Practice Address - Street 1:5521 BELLAIRE DR S STE 210
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5900
Practice Address - Country:US
Practice Address - Phone:817-623-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41305122300000X, 1223P0221X
NJ22DI02761700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid