Provider Demographics
NPI:1275707119
Name:ALPHA OMEGA DENTAL
Entity Type:Organization
Organization Name:ALPHA OMEGA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNGJA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-692-7333
Mailing Address - Street 1:2821 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2605
Mailing Address - Country:US
Mailing Address - Phone:405-692-7333
Mailing Address - Fax:405-692-7336
Practice Address - Street 1:2821 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2605
Practice Address - Country:US
Practice Address - Phone:405-692-7333
Practice Address - Fax:405-692-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty