Organization
OMNI DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PE CHANG D.D.S. (CO-OWNER)
(505) 888-5131
Entity
Organization
Contact information
Practice address
7111 PROSPECT PL NE, SUITE B, ALBUQUERQUE, NM 87110-4309
(505) 888-5131
(505) 888-5135
Mailing address
7111 PROSPECT PL NE, SUITE B, ALBUQUERQUE, NM 87110-4309
(505) 888-5131
(505) 888-5135
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2344
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1505220
UNITED CONCORDIA
—
05
—
55120725
—
NM
Enumeration date
07/29/2011
Last updated
07/29/2011
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