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General NPI Number Information
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NPI Number | 1598959538
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Entity Type | Organization
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Legal Business Name | OMS FACILITY SERVICES LLC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 411 BILLINGSLEY RD SUITE 105
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City | CHARLOTTE
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State | NC
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Zip | 28211-1046
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Country | US
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Telephone | 704-820-2982
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Fax | 704-820-3185
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Provider Business Mailing Address
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Address Line | 411 BILLINGSLEY RD SUITE 105
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City | CHARLOTTE
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State | NC
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Zip | 28211-1046
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Country | US
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Telephone | 704-820-2982
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Fax | 704-820-3185
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MR. DANNY KETOLA
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Credential |
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Telephone | 704-820-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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