Provider Demographics
NPI:1346447711
Name:OMARI ONYANGO DDS A PROFESSIONAL
Entity Type:Organization
Organization Name:OMARI ONYANGO DDS A PROFESSIONAL
Other - Org Name:PALMDALE FAMILY DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYANGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-843-5400
Mailing Address - Street 1:12384 PALMDALE RD.
Mailing Address - Street 2:# 204
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392
Mailing Address - Country:US
Mailing Address - Phone:760-843-5400
Mailing Address - Fax:760-843-5465
Practice Address - Street 1:12384 PALMDALE RD
Practice Address - Street 2:204
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8506
Practice Address - Country:US
Practice Address - Phone:760-843-5400
Practice Address - Fax:760-843-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty