Provider Demographics
NPI:1033285978
Name:OMNI DENTAL GROUP
Entity Type:Organization
Organization Name:OMNI DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLEY-HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-250-5012
Mailing Address - Street 1:12335 HYMEADOW DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1934
Mailing Address - Country:US
Mailing Address - Phone:512-250-5012
Mailing Address - Fax:512-219-8510
Practice Address - Street 1:12335 HYMEADOW DR
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1934
Practice Address - Country:US
Practice Address - Phone:512-250-5012
Practice Address - Fax:512-219-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty