Provider Demographics
NPI:1740040682
Name:OMNI ON PREMISES
Entity type:Organization
Organization Name:OMNI ON PREMISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-450-7329
Mailing Address - Street 1:4647 LONG BEACH BLVD STE D5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-6976
Mailing Address - Country:US
Mailing Address - Phone:562-453-0525
Mailing Address - Fax:562-980-0020
Practice Address - Street 1:4647 LONG BEACH BLVD STE D5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6976
Practice Address - Country:US
Practice Address - Phone:562-453-0525
Practice Address - Fax:562-980-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty