Provider Demographics
NPI:1598877755
Name:O'MEARA DENTAL
Entity Type:Organization
Organization Name:O'MEARA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:O'MEARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-243-0591
Mailing Address - Street 1:1000 73RD STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311
Mailing Address - Country:US
Mailing Address - Phone:515-243-0591
Mailing Address - Fax:515-243-0592
Practice Address - Street 1:1000 73RD STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311
Practice Address - Country:US
Practice Address - Phone:515-243-0591
Practice Address - Fax:515-243-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152157Medicaid
IA15215OtherBCBS
980874OtherUNITED CONCORDIA TRICARE