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Organization
ID OMS SPECIALTY DENTAL SERVICES, PLLC
Active
Organization
ID OMS SPECIALTY DENTAL SERVICES, PLLC
Active
Other names
Specialty Dental Brands
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (DIRECTOR OF PROVIDER RELATIONS)
(504) 638-0303
Entity
Organization
Contact information
Practice address
1859 N LAKEWOOD DR STE 101, COEUR D ALENE, ID 83814-2661
(208) 667-5565
Mailing address
401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
(504) 638-0303
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/30/2021
Last updated
08/30/2021
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