| Omnia Dental Care | |
|
15911 Pomona Rincon Rd Ste 120 Chino Hills CA 91709-5567 | |
| (909) 497-9449 | |
| (844) 600-4099 |
| Full Name | Omnia Dental Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 15911 Pomona Rincon Rd Ste 120, Chino Hills, California |
| Authorized Official Name and Position | Carrick Bannatz (OFFICE MANAGER) |
| Authorized Official Contact | 9094979449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omnia Dental Care 15911 Pomona Rincon Rd Ste 120 Chino Hills CA 91709-5567 Ph: (909) 497-9449 | Omnia Dental Care 15911 Pomona Rincon Rd Ste 120 Chino Hills CA 91709-5567 Ph: (909) 497-9449 |
| NPI Number | 1801461561 |
|---|---|
| Provider Enumeration Date | 05/25/2021 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 6406219450 |
|---|---|
| Medicare Enrollment ID | O20230824000888 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801461561 | NPI | - | NPPES |
| 65123 | Other | CA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Maria Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053778241 PECOS PAC ID: 0446531230 Enrollment ID: I20230829000428 |
| Provider Name | Rupporn Priyawat |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1033453667 PECOS PAC ID: 0244545739 Enrollment ID: I20230912003267 |
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