Provider Demographics
NPI:1679178206
Name:OMSCOR LLC
Entity type:Organization
Organization Name:OMSCOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:864-420-2738
Mailing Address - Street 1:1140 WOODRUFF RD STE 106-180
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4172
Mailing Address - Country:US
Mailing Address - Phone:864-420-2738
Mailing Address - Fax:
Practice Address - Street 1:218 WALL ST
Practice Address - Street 2:
Practice Address - City:POWDERSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29673-6754
Practice Address - Country:US
Practice Address - Phone:864-420-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty