Provider Demographics
NPI:1477142347
Name:ALKHALIDI, OMEED
Entity type:Individual
Prefix:
First Name:OMEED
Middle Name:
Last Name:ALKHALIDI
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 1:19935 COSTA BELLA POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8363
Mailing Address - Country:US
Mailing Address - Phone:916-494-4612
Mailing Address - Fax:
Practice Address - Street 1:21356 KUYKENDAHL RD STE B
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2607
Practice Address - Country:US
Practice Address - Phone:346-459-6040
Practice Address - Fax:346-459-6055
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFA99367351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice