Organization
PRIYAWAT AND KIM DENTAL SERVICES
Active
Other names
Omnia Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARRICK BANNATZ (OFFICE MANAGER)
(909) 497-9449
Entity
Organization
Contact information
Practice address
15911 POMONA RINCON RD STE 120, CHINO HILLS, CA 91709-5567
(909) 497-9449
(844) 600-4099
Mailing address
15911 POMONA RINCON RD STE 120, CHINO HILLS, CA 91709-5567
(909) 497-9449
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65123
DENTAL LICENSE
CA
Enumeration date
05/25/2021
Last updated
08/22/2023
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