Individual provider Active NPI

Omar Abuhajleh, DMD

  • Dentist
  • Fredericksburg, VA
National Provider Identifier
1427244615
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401412655 Issued in VA
Practice address
10505 Rising Ridge Rd Apt 604
Fredericksburg, VA 22407-8235
Phone
(781) 254-2626
NPI assigned
Sep 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401412655 VA Primary

Addresses

Primary practice location

10505 Rising Ridge Rd Apt 604
Fredericksburg, VA 22407-8235

Mailing address

10505 Rising Ridge Rd Apt 604
Fredericksburg, VA 22407-8235
Phone (781) 254-2626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0401412655VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Smile LLC Current Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289520000000",
    "number": "1427244615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 RISING RIDGE RD APT 604",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224078235",
            "telephone_number": "781-254-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 RISING RIDGE RD APT 604",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224078235",
            "telephone_number": "781-254-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABUHAJLEH",
        "first_name": "OMAR",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-20",
        "last_updated": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.