Omar Hassan Elkhabbaz, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

26510 Issued in FL

Practice address

7777 N Wickham Rd
Melbourne, FL 32940-7976

Phone

(321) 255-6303

NPI assigned

Oct 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1649933151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 MILANO LN APT 207",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408171",
            "telephone_number": "857-308-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407976",
            "telephone_number": "321-255-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKHABBAZ",
        "first_name": "OMAR",
        "middle_name": "HASSAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "26510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Kolb-Jackson, LLC
• Angel G Elizechea Hernandez, SAC
• Nour Elkhatib, DMD
• Sara Ellefson
• Denise Elliott, RN CRNI
• Mary Catherine Elliott, MD
• Petra Gabriele Elliott, MS

• General Practice Dentistry in Melbourne, FL
• Providers in Melbourne, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.