=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275905176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNI DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2015
-----------------------------------------------------
Last Update Date | 10/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4654 S COOPER ST 316
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76017-5865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-557-0095
-----------------------------------------------------
Fax | 817-557-1805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4654 S COOPER ST 316
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76017-5865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-557-0095
-----------------------------------------------------
Fax | 817-557-1805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID MARCUS CHEI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 214-326-9077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------