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Organization
OMAR DYAB DDS PA
Active
Organization
OMAR DYAB DDS PA
Active
Other names
1st Family Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR DYAB DDS (OWNER)
(763) 428-1215
Entity
Organization
Contact information
Practice address
13590 NORTHDALE BLVD, SUITE 300, ROGERS, MN 55374-2150
(763) 428-1215
(763) 428-1398
Mailing address
13590 NORTHDALE BLVD, SUITE 300, ROGERS, MN 55374-2150
(763) 428-1215
(763) 428-1398
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
D12346
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235267980
—
MN
Enumeration date
02/15/2010
Last updated
02/15/2010
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