Provider Demographics
NPI:1114320983
Name:A OMEGA DENTAL, LLC
Entity type:Organization
Organization Name:A OMEGA DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-722-8423
Mailing Address - Street 1:6775 E LAKE MEAD BLVD
Mailing Address - Street 2:STE # B9 & B10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156
Mailing Address - Country:US
Mailing Address - Phone:702-570-5072
Mailing Address - Fax:702-570-5384
Practice Address - Street 1:6775 E LAKE MEAD BLVD
Practice Address - Street 2:STE # B9 & B10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156
Practice Address - Country:US
Practice Address - Phone:702-570-5072
Practice Address - Fax:702-570-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty