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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