Provider Demographics
NPI:1881326379
Name:O'MEARA, THOMAS JOSEPH GODINEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS JOSEPH
Middle Name:GODINEZ
Last Name:O'MEARA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 LONNIE ABBOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1851
Mailing Address - Country:US
Mailing Address - Phone:580-279-1716
Mailing Address - Fax:
Practice Address - Street 1:1430 LONNIE ABBOTT BLVD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1851
Practice Address - Country:US
Practice Address - Phone:580-279-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice