Organization
OMNI DENTAL CENTRES, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WALLACE HURLEY D.D.S. (DENTIST/OWNER)
(712) 347-6151
Entity
Organization
Contact information
Practice address
1026 WOODBURY AVE, COUNCIL BLUFFS, IA 51503-7915
(712) 328-8573
(712) 328-0233
Mailing address
3004 N 13TH ST, CARTER LAKE, IA 51510-1438
(712) 347-6151
(712) 847-0164
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6855
IA
1223G0001X
General Practice Dentistry
8132
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07881
BLUE CROSS BLUE SHIELD
NE
01
—
20363
BLUE CROSS BLUE SHIELD
IA
01
—
628884
UNITED CONCORDIA
—
Enumeration date
07/22/2006
Last updated
06/03/2011
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