Healthcare Provider Details

I. General information

NPI: 1821584681
Provider Name (Legal Business Name): OMFS ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 S ROCHESTER RD STE 2500
ROCHESTER HILLS MI
48307-5160
US

IV. Provider business mailing address

3950 S ROCHESTER RD STE 2500
ROCHESTER HILLS MI
48307-5160
US

V. Phone/Fax

Practice location:
  • Phone: 586-770-0612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DIANA TIEU
Title or Position: INSURANCE BILLER
Credential:
Phone: 734-306-5404