Provider Demographics
NPI:1407040348
Name:OMNICARE DENTAL ASSOCIATES, P. A.
Entity Type:Organization
Organization Name:OMNICARE DENTAL ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-359-6000
Mailing Address - Street 1:5068 W PLANO PKWY
Mailing Address - Street 2:SUITE 224
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4408
Mailing Address - Country:US
Mailing Address - Phone:972-447-0220
Mailing Address - Fax:
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 320
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2901
Practice Address - Country:US
Practice Address - Phone:972-359-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty