Provider Demographics
NPI:1548470370
Name:ALPHA & OMEGA DENTAL, LLP
Entity type:Organization
Organization Name:ALPHA & OMEGA DENTAL, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SE-A
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-351-5158
Mailing Address - Street 1:220 ROUTE 17
Mailing Address - Street 2:P.O. BOX 625
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4410
Mailing Address - Country:US
Mailing Address - Phone:845-351-5158
Mailing Address - Fax:
Practice Address - Street 1:220 ROUTE 17
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-4410
Practice Address - Country:US
Practice Address - Phone:845-351-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0517401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty