Provider Demographics
NPI:1760826291
Name:F. JAY OHMES DDS LLC
Entity Type:Organization
Organization Name:F. JAY OHMES DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:OHMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-978-0226
Mailing Address - Street 1:1009 RONDALE CT
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7368
Mailing Address - Country:US
Mailing Address - Phone:636-978-0226
Mailing Address - Fax:
Practice Address - Street 1:1009 RONDALE CT
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-7368
Practice Address - Country:US
Practice Address - Phone:636-978-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015092122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7546410001Medicare NSC