# ID OMS SPECIALTY DENTAL SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Specialty Dental Brands
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366119075
- **Authorized official:** CHARLOTTE DASCH (DIRECTOR OF PROVIDER RELATIONS)
- **Authorized official phone:** (504) 638-0303

## Contact information

- **Practice address:** 1859 N LAKEWOOD DR STE 101, COEUR D ALENE, ID 83814-2661
- **Practice address phone:** (208) 667-5565
- **Mailing address:** 401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
- **Mailing address phone:** (504) 638-0303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2021
- **Last updated:** 08/30/2021