Provider Demographics
NPI:1154620102
Name:OMEY, LUKE ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ANDREW
Last Name:OMEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 HARRISON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4738
Mailing Address - Country:US
Mailing Address - Phone:707-443-7877
Mailing Address - Fax:707-443-7657
Practice Address - Street 1:2752 HARRISON AVE STE B
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4738
Practice Address - Country:US
Practice Address - Phone:707-443-7877
Practice Address - Fax:707-443-7657
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist