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NPI Code Detail

MEDICARE: OMNI DENTAL, PLLC

MEDICARE: OMNI DENTAL, PLLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1386275667
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMNI DENTAL, PLLC
Provider Business Mailing Address
First Line : 3035 WASHINGTON RD STE 3
Second Line :
City : MC MURRAY
State : PA
Zip : 15317-3281
Country : US
Telephone Number : 724-941-2200
Fax Number : 724-941-5810
Provider Business Practice Location Address
First Line : 3035 WASHINGTON RD STE 3
Second Line :
City : MC MURRAY
State : PA
Zip : 15317-3281
Country : US
Telephone Number : 724-941-2200
Fax Number : 724-941-5810
Authorized Official
Title or Position : FRONT OFFICE MANAGER
Name : CRYSTAL CZINA
Credential :
Telephone Number : 724-941-2200
Provider Enumeration Date : 01/27/2020
Last Update Date : 02/06/2020

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