Provider Demographics
NPI:1972271146
Name:ALPHA OMEGA DENTAL PLLC
Entity type:Organization
Organization Name:ALPHA OMEGA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-885-4311
Mailing Address - Street 1:6060 RICHMOND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6060 RICHMOND AVE STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6262
Practice Address - Country:US
Practice Address - Phone:832-767-3331
Practice Address - Fax:832-538-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental