Omni Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DD2344 Issued in NM

Legal business name

OMNI DENTAL, LLC

Practice address

7111 Prospect PL NE
Suite B
Albuquerque, NM 87110-4309

Phone

(505) 888-5131

Fax

(505) 888-5135

NPI assigned

Jul 29, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pe Chang, D.D.S.NPI 1093813354

Title

Co-Owner

Phone

(505) 888-5131

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pe Chang, D.D.S.

  • Dentist
  • Albuquerque, NM
  • NPI 1093813354
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311897600000",
    "number": "1629356209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7111 PROSPECT PL NE",
            "address_2": "SUITE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871104309",
            "telephone_number": "505-888-5131",
            "fax_number": "505-888-5135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7111 PROSPECT PL NE",
            "address_2": "SUITE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871104309",
            "telephone_number": "505-888-5131",
            "fax_number": "505-888-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-29",
        "last_updated": "2011-07-29",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "PE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "505-888-5131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1505220",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55120725",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Joseph Oman
• Stephanie Rabara Omer
• Laura Audrey Omidvaran, R.D.
• Leila Omidvaran, SLP-CF
• Abigail Eileen Omlor, LPCC LPAT ATR-BC
• Omni Medical Group LLC
• Omnisleep LLC
• Omnisleep LLC
• On Call Health Services of New Mexico LLC
• On Site Radiography, Inc.

• Dentist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.