MEDICARE: OMEGA ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1316049851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA ORTHODONTICS

Provider Business Mailing Address
First Line	:	PO BOX 61970
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76906
Country	:	US
Telephone Number	:	325-949-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3123 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904
Country	:	US
Telephone Number	:	325-949-4100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ILENE LOUISE REES
Credential	:	DDS, MSD
Telephone Number	:	325-949-4100

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	08/28/2019

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Directions to “OMEGA ORTHODONTICS ” Practice Location

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