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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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