Provider Demographics
NPI:1902872989
Name:OMIDO, GILBERT R (DDS)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:OMIDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3916
Mailing Address - Country:US
Mailing Address - Phone:316-683-0440
Mailing Address - Fax:316-689-0300
Practice Address - Street 1:7207 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3916
Practice Address - Country:US
Practice Address - Phone:316-683-0440
Practice Address - Fax:316-689-0300
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist