MEDICARE: ALPHA OMEGA DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5407	OK

General Provider Information

NPI Number	:	1275707119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA OMEGA DENTAL

Provider Business Mailing Address
First Line	:	2821 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-692-7333
Fax Number	:	405-692-7336

Provider Business Practice Location Address
First Line	:	2821 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2605
Country	:	US
Telephone Number	:	405-692-7333
Fax Number	:	405-692-7336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KYUNGJA KAY CHO
Credential	:	D.D.S
Telephone Number	:	405-692-7333

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	06/17/2008

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