Provider Demographics
NPI:1083501100
Name:ALBAYATI, OMAR
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ALBAYATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 VERSAILLES PKWY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-6019
Mailing Address - Country:US
Mailing Address - Phone:331-425-2540
Mailing Address - Fax:
Practice Address - Street 1:2442 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2050
Practice Address - Country:US
Practice Address - Phone:815-748-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0361441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice