Provider Demographics
NPI:1730599887
Name:OMEGA DENTAL GROUP, P.A.
Entity type:Organization
Organization Name:OMEGA DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPREHENSIVE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-671-1017
Mailing Address - Street 1:7200 ALOMA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7133
Mailing Address - Country:US
Mailing Address - Phone:407-671-1017
Mailing Address - Fax:407-678-1339
Practice Address - Street 1:7200 ALOMA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7133
Practice Address - Country:US
Practice Address - Phone:407-671-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty