Munder Omran Ben-Omran, BDS
Individual provider Active NPI Dentist · Cheney, WA
NPI 1053918862 · NPPES record last updated Nov 4, 2021
Key facts
- NPI
- 1053918862
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE60963290 (WA)
- Practice address
- 1720 2ND St
Cheney, WA 99004-1910 - Phone
- (509) 444-8200
- NPI assigned
- Oct 5, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210915002753 | WA | Order and Referring Only - Dentist |
5294131389 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60963290 | WA | Yes |
Addresses
Primary practice location
1720 2ND St
Cheney, WA 99004-1910
Mailing address
611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Munder | Health Information Exchange (HIE) |
Other providers in Cheney, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.