Healthcare Provider Details

I. General information

NPI: 1245303387
Provider Name (Legal Business Name): OMEGA ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OMEGA DR SUITE J-31
NEWARK DE
19713-2058
US

IV. Provider business mailing address

31 OMEGA DR SUITE J-31
NEWARK DE
19713-2058
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-7600
  • Fax: 302-733-7522
Mailing address:
  • Phone: 302-733-7600
  • Fax: 302-733-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2005207676
License Number StateDE

VIII. Authorized Official

Name: DR. DONALD T. LIU
Title or Position: PARTNER ENDODONTIST
Credential: D.M.D.
Phone: 302-733-7600