Provider Demographics
NPI:1700889474
Name:OMI, SHELDON R (DMD PC)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:R
Last Name:OMI
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 W 44TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4563
Mailing Address - Country:US
Mailing Address - Phone:303-422-7978
Mailing Address - Fax:303-422-7979
Practice Address - Street 1:7900 W 44TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4563
Practice Address - Country:US
Practice Address - Phone:303-422-7978
Practice Address - Fax:303-422-7979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO62161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice