Provider Demographics
NPI:1235547027
Name:OMEGA DENTISTRY MANAGEMENT GROUP INC.
Entity Type:Organization
Organization Name:OMEGA DENTISTRY MANAGEMENT GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHLULI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-209-2215
Mailing Address - Street 1:106 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5509
Mailing Address - Country:US
Mailing Address - Phone:832-209-2215
Mailing Address - Fax:
Practice Address - Street 1:106 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5509
Practice Address - Country:US
Practice Address - Phone:832-209-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty