Omar Dyab DDS PA

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

D12346 Issued in MN

Legal business name

OMAR DYAB DDS PA

Doing business as

1st Family Dental Care

Practice address

13590 Northdale Blvd
Suite 300
Rogers, MN 55374-2150

Phone

(763) 428-1215

Fax

(763) 428-1398

NPI assigned

Feb 15, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Omar Dyab, DDS

Title

Owner

Phone

(763) 428-1215

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 1st Family Dental Care Doing business as

Locations

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266192000000",
    "number": "1801118039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13590 NORTHDALE BLVD",
            "address_2": "SUITE 300",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553742150",
            "telephone_number": "763-428-1215",
            "fax_number": "763-428-1398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13590 NORTHDALE BLVD",
            "address_2": "SUITE 300",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553742150",
            "telephone_number": "763-428-1215",
            "fax_number": "763-428-1398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMAR DYAB DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-15",
        "last_updated": "2010-02-15",
        "status": "A",
        "authorized_official_last_name": "DYAB",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-428-1215",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "MN",
            "license": "D12346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235267980",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1st Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Public Health Dentistry in Rogers, MN
• Providers in Rogers, MN by specialty
• Public Health Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.