Omar Al-Kazaz
Individual provider Active NPI Dentist · Bridgewater, MA
NPI 1265077655 · NPPES record last updated Jun 5, 2023
Key facts
- NPI
- 1265077655
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN1858508 (MA)
- Practice address
- 23 Union St
Bridgewater, MA 02324-1412 - Phone
- (508) 697-6596
- NPI assigned
- Nov 9, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1858508 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental HQ LLC | Current |
Accepting new patients | |
| Dental HQB PLLC | Current | Accepting new patients | |
| Alpha Dental Center of Fall River, LLC | Past |
Accepting new patients | |
| Daniel O. Coyne D.D.S., P.C. | Dentist | Past |
Accepting new patients |
Locations
23 Union St
Bridgewater, MA 02324
Phone (508) 697-6596
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1858508 | MA | Yes |
Addresses
Primary practice location
23 Union St
Bridgewater, MA 02324-1412
Mailing address
23 Union St
Bridgewater, MA 02324-1412
Other providers in Bridgewater, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.