Omar Moukaddem, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.033148 Issued in IL

Practice address

200 W Lake St
Addison, IL 60101-2513

Phone

(630) 628-3115

NPI assigned

Jun 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Viva Smile Dental PLLC

  • Dental Clinic/Center
  • Chicago, IL
  • NPI 1942090329
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1336718659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012513",
            "telephone_number": "630-628-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601012513",
            "telephone_number": "630-628-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUKADDEM",
        "first_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony F Morelli, D.D.S
• Latoya Morgan
• Vilma L Morocho
• Brian H Morrell, PT
• Kyrne A Morris
• Anastasia Munoz, MD
• Gazanfer Mushtaq, PT
• Michael Walter Naborowski, D.D.S.
• Iliass Najimi, DC
• Aimee Lynn Naleway, PA-C

• Dentist in Addison, IL
• Providers in Addison, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.