Mark R Omlie, D.D.S.-M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DO8081 Issued in MN

Practice address

7373 France Ave S
Suite 602
Edina, MN 55435-4534

Phone

(952) 835-5003

Fax

(952) 835-9598

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral and Maxillofacial Surgical Consultants PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Chanhassen, MN
  • NPI 1316165012
  Medicare reassignment NPD
• Oral and Maxillofacial Surgical Consultants PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Wayzata, MN
  • NPI 1265650956
  NPD
• Oral and Maxillofacial Surgical Consultants PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Edina, MN
  • NPI 1619049921
  NPD
• Oral and Maxillofacial Surgical Consultants PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Chanhassen, MN
  • NPI 1720206428
  NPD

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391644800000",
    "number": "1942272489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S",
            "address_2": "SUITE 602",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354534",
            "telephone_number": "952-835-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S",
            "address_2": "SUITE 602",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354534",
            "telephone_number": "952-835-5003",
            "fax_number": "952-835-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMLIE",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.-M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2014-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "DO8081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "130740M",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA NUMBER",
            "identifier": "86-14849",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Najma Ahmed Omar
• Weheliye Ali Omar
• Omart Women Supporting Women
• Danly Osmary Omil-Lima, MD
• James Joseph Omlie, D.D.S.
• William R. Omlie, M.D.
• Omni HHC, Inc. (CareMinders Home Care)
• Michael Omomo
• On-Site Dentistry (On-Site Podiatry Services)
• On-Site Dentistry

• Oral and Maxillofacial Surgery (Dentist) in Edina, MN
• Providers in Edina, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.