| Omni Dental, Llc | |
|
7111 Prospect Pl Ne Suite B Albuquerque NM 87110-4309 | |
| (505) 888-5131 | |
| (505) 888-5135 |
| Full Name | Omni Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 7111 Prospect Pl Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Pe Chang (CO-OWNER) |
| Authorized Official Contact | 5058885131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Dental, Llc 7111 Prospect Pl Ne Suite B Albuquerque NM 87110-4309 Ph: (505) 888-5131 | Omni Dental, Llc 7111 Prospect Pl Ne Suite B Albuquerque NM 87110-4309 Ph: (505) 888-5131 |
| NPI Number | 1629356209 |
|---|---|
| Provider Enumeration Date | 07/29/2011 |
| Last Update Date | 07/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629356209 | NPI | - | NPPES |
| 1505220 | Other | UNITED CONCORDIA | |
| 55120725 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD2344 (New Mexico) | Primary |
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