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General NPI Number Information
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NPI Number | 1942901467
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Entity Type | Organization
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Legal Business Name | OMNI FAMILY DENTAL LLC
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 11/25/2023
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Provider Practice Location Address
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Address Line | 3900 SATELLITE BLVD STE 106
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City | DULUTH
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State | GA
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Zip | 30096-1861
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Country | US
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Telephone | 678-865-7974
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 SATELLITE BLVD STE 106
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City | DULUTH
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State | GA
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Zip | 30096-1861
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Country | US
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Telephone | 678-395-3692
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. CHRISTINA GOMEZ
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Credential |
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Telephone | 678-395-3692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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