Healthcare Provider Details

I. General information

NPI: 1336581297
Provider Name (Legal Business Name): JAMES JOSEPH OMLIE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2013
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S STE 602
EDINA MN
55435-4552
US

IV. Provider business mailing address

7373 FRANCE AVE S STE 602
EDINA MN
55435-4552
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-5003
  • Fax:
Mailing address:
  • Phone: 952-835-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9846
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: