Omar Mario Masabni, B.D.S., D.D.S., M.S.
Individual provider Active NPI Periodontics · Village of Clarkston, MI
NPI 1477089431 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1477089431
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 2901600593 (MI)
- Practice address
- 6803 Dixie Hwy
Village of Clarkston, MI 48346 - Phone
- (248) 625-1721
- NPI assigned
- May 11, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901600593 | MI | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Troy Periodontics & Dental Implants | Periodontics | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2901600593 | MI | Yes |
Addresses
Primary practice location
6803 Dixie Hwy
Village of Clarkston, MI 48346
Mailing address
6803 Dixie Hwy
Village of Clarkston, MI 48346
Phone (248) 625-1721
Other providers in Village of Clarkston, MI
All providers in Village of Clarkston, MI · Periodontics in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. 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.