Provider Demographics
NPI:1437378601
Name:OMNI DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:OMNI DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-809-0029
Mailing Address - Street 1:4321 COLLINGTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2263
Mailing Address - Country:US
Mailing Address - Phone:301-809-0029
Mailing Address - Fax:301-809-0894
Practice Address - Street 1:4321 COLLINGTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2263
Practice Address - Country:US
Practice Address - Phone:301-809-0029
Practice Address - Fax:301-809-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty