Provider Demographics
NPI:1275120289
Name:OMEGA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OMEGA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADELANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIMBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-422-9445
Mailing Address - Street 1:2851 COBB PKWY NW STE 208
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2717
Mailing Address - Country:US
Mailing Address - Phone:770-422-9445
Mailing Address - Fax:770-422-9892
Practice Address - Street 1:2851 COBB PKWY NW STE 208
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2717
Practice Address - Country:US
Practice Address - Phone:770-422-9445
Practice Address - Fax:770-422-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental