Provider Demographics
NPI:1245303387
Name:OMEGA ENDODONTICS, LLC
Entity type:Organization
Organization Name:OMEGA ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-733-7600
Mailing Address - Street 1:31 OMEGA DR
Mailing Address - Street 2:SUITE J-31
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2058
Mailing Address - Country:US
Mailing Address - Phone:302-733-7600
Mailing Address - Fax:302-733-7522
Practice Address - Street 1:31 OMEGA DR
Practice Address - Street 2:SUITE J-31
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2058
Practice Address - Country:US
Practice Address - Phone:302-733-7600
Practice Address - Fax:302-733-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20052076761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1576242OtherUNITED CONCORDIA PROVIDER