Walied Eldomiaty, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9897 Issued in KY

Practice address

4055 Mercantile Dr Apt 374
Lake Oswego, OR 97035-2633

Phone

(202) 285-8313

NPI assigned

Jul 1, 2019

Last updated

Apr 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1881256766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 MERCANTILE DR APT 374",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352633",
            "telephone_number": "202-285-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 MERCANTILE DR APT 374",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352633",
            "telephone_number": "202-285-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDOMIATY",
        "first_name": "WALIED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-01",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9897",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D11696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy John Edvalson, D.M.D.
• Emma Edwards
• Lauren Edwards, LCSW
• Stephen Eguia
• Karrie Marie J Ehlers, PSYD
• Elisa a. Burgess, MD, PC
• Nicole Elledge, OTR
• John F Elliott
• Megan Elliott, MT-BC
• Tamara M Ellis, PHH (MFT)

• Dentist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.