Organization Active NPI

Omni on Premises

  • General Practice Dentistry
  • Long Beach, CA
National Provider Identifier
1740040682
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OMNI ON PREMISES
Practice address
4647 Long Beach Blvd Ste D5
Long Beach, CA 90805-6976
Phone
(562) 453-0525
Fax
(562) 980-0020
NPI assigned
Mar 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Christopher Doane, DDSNPI 1710255971
Title
Doctor
Phone
(805) 450-7329

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Oral and Maxillofacial Radiology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0008X

Addresses

Primary practice location

4647 Long Beach Blvd Ste D5
Long Beach, CA 90805-6976

Mailing address

4647 Long Beach Blvd Ste D5
Long Beach, CA 90805-6976
Phone (562) 453-0525

National Provider Directory

National Provider Directory

Locations

4647 Long Beach Blvd
Ste D5
Long Beach, CA 90805
Phone (562) 453-0525

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1740040682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 LONG BEACH BLVD STE D5",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908056976",
            "telephone_number": "562-453-0525",
            "fax_number": "562-980-0020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 LONG BEACH BLVD STE D5",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908056976",
            "telephone_number": "562-453-0525",
            "fax_number": "562-980-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI ON PREMISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "DOANE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "805-450-7329",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.