Individual
MOHAMEDTAREK A OMRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BDS
Contact information
Practice address
2800 COLLEGE AVE, ALTON, IL 62002-4742
(618) 474-7000
Mailing address
2615 SPYGLASS CT, APT B, EDWARDSVILLE, IL 62025-3672
(314) 546-5628
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028913
IL
Other
Enumeration date
08/02/2012
Last updated
08/02/2012
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