Provider Demographics
NPI:1528696184
Name:ALPHA AND OMEGA DENTISTRY, INC.
Entity type:Organization
Organization Name:ALPHA AND OMEGA DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-551-2003
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-0695
Mailing Address - Country:US
Mailing Address - Phone:601-551-2003
Mailing Address - Fax:601-657-5936
Practice Address - Street 1:1620 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-5502
Practice Address - Country:US
Practice Address - Phone:601-551-2003
Practice Address - Fax:601-657-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty