Provider Demographics
NPI:1598971491
Name:O'MEARA, DENNIS P (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:O'MEARA
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 1:1000 73RD ST.
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 ST.
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152157Medicaid
IA15215OtherBCBS
980874OtherUNITED CONCORDIA TRICARE