Provider Demographics
NPI:1396113668
Name:ANITA OMIDI, D.D.S. PC
Entity type:Organization
Organization Name:ANITA OMIDI, D.D.S. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:760-434-2526
Mailing Address - Street 1:1273 LAS FLORES DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-845-5925
Mailing Address - Fax:
Practice Address - Street 1:1273 LAS FLORES DRIVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1030
Practice Address - Country:US
Practice Address - Phone:760-845-5925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty