Active NPI
Omar Fetouh, D.D.S
- Orthodontics and Dentofacial Orthopedics Dentistry
- Saginaw, TX
National Provider Identifier
1992950042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 24314
- Practice address
- 900 N Blue Mound Rd
Suite 128
Saginaw, TX 76131-4810 - Phone
- (716) 348-9855
- NPI assigned
- Nov 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 24314 | TX | Primary |
Addresses
Primary practice location
900 N Blue Mound Rd
Suite 128
Saginaw, TX 76131-4810
Mailing address
900 N Blue Mound Rd
Suite 128
Saginaw, TX 76131-4810
Phone (716) 348-9855
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467674309 | Medicaid | TX | |
| 1568871523 | Medicaid | TX |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 24314 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omar Fetouh, D.D.S., M.S., P.C. | Orthodontics and Dentofacial Orthopedics | 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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Saginaw, TX
- NPI 1093028169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446076800000",
"number": "1992950042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 N BLUE MOUND RD",
"address_2": "SUITE 128",
"city": "SAGINAW",
"state": "TX",
"postal_code": "761314810",
"telephone_number": "716-348-9855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N BLUE MOUND RD",
"address_2": "SUITE 128",
"city": "SAGINAW",
"state": "TX",
"postal_code": "761314810",
"telephone_number": "716-348-9855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETOUH",
"first_name": "OMAR",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-17",
"last_updated": "2015-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "24314",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1467674309",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1568871523",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.