Provider Demographics
NPI:1376645523
Name:OMAN, EDWARD RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAY
Last Name:OMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133
Mailing Address - Country:US
Mailing Address - Phone:816-358-4428
Mailing Address - Fax:816-358-4460
Practice Address - Street 1:6115 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-358-4428
Practice Address - Fax:816-358-4460
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO010460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0010460MOOtherDELTA DENTAL
MO05471012OtherBLUE CROSS BLUE SHIELD
MO70408OtherFORTIS
MO716511OtherUNITED CONCORDIA