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
—
—
Other
Enumeration date
08/30/2021
Last updated
08/30/2021
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