Healthcare Provider Details

I. General information

NPI: 1588555379
Provider Name (Legal Business Name): EVA-ELIZABETH FAY O'MELIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR STE 325
FRISCO CO
80443-5948
US

IV. Provider business mailing address

2170 S MCCLELLAND ST APT 512
SALT LAKE CITY UT
84106-1015
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-4055
  • Fax:
Mailing address:
  • Phone: 715-493-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206621
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: