Provider Demographics
NPI:1366080905
Name:OMNI ENDODONTICS, PLLC
Entity type:Organization
Organization Name:OMNI ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODADADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-666-9267
Mailing Address - Street 1:1397 GEORGE DIETER DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7681
Mailing Address - Country:US
Mailing Address - Phone:310-666-9267
Mailing Address - Fax:915-248-3615
Practice Address - Street 1:1397 GEORGE DIETER DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7681
Practice Address - Country:US
Practice Address - Phone:310-666-9267
Practice Address - Fax:915-248-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty