Provider Demographics
NPI:1003429515
Name:OMEGA DENTAL CARE, P.A.
Entity Type:Organization
Organization Name:OMEGA DENTAL CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBERAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-460-9100
Mailing Address - Street 1:1161 WAYZATA BLVD E # 210
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6203 DELL RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1122
Practice Address - Country:US
Practice Address - Phone:952-460-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental