Healthcare Provider Details

I. General information

NPI: 1992543292
Provider Name (Legal Business Name): OMSA DB PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SE 6TH AVE
DELRAY BEACH FL
33483-5263
US

IV. Provider business mailing address

505 SE 6TH AVE STE C
DELRAY BEACH FL
33483-5263
US

V. Phone/Fax

Practice location:
  • Phone: 561-278-0004
  • Fax: 561-278-0005
Mailing address:
  • Phone: 561-278-0004
  • Fax: 561-278-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: RAMON A PEREZ-ROSICH
Title or Position: PRESIDENT
Credential:
Phone: 954-693-0026