Provider Demographics
NPI:1669502464
Name:O'MELIA, JOHN P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:O'MELIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8894 FORT SMALLWOOD RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7612
Mailing Address - Country:US
Mailing Address - Phone:410-255-8800
Mailing Address - Fax:410-255-8873
Practice Address - Street 1:8894 FORT SMALLWOOD RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7612
Practice Address - Country:US
Practice Address - Phone:410-255-8800
Practice Address - Fax:410-255-8873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice