Omar Harbey Eloustaz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DDS106893 Issued in CA

Practice address

16633 Ventura Blvd Ste 850
Encino, CA 91436-1846

Phone

(818) 990-5900

NPI assigned

Oct 4, 2021

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Omar Eloustaz Dental Corporation

  • Dental Clinic/Center
  • Encino, CA
  • NPI 1356033252
  NPD Authorized official
• Tilden Bay Joseph Dental Group

  dba Green Dental and Orthodontics

  • Dentist
  • Sherman Oaks, CA
  • NPI 1750981478
  NPD (past)
• Tilden Bay Joseph Dental Group

  dba Green Dental & Orthodontics

  • General Practice Dentistry
  • Sherman Oaks, CA
  • NPI 1841627825
  NPD (past)

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1912679358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 NEENACH ST",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913523043",
            "telephone_number": "818-579-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16633 VENTURA BLVD STE 850",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361846",
            "telephone_number": "818-990-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELOUSTAZ",
        "first_name": "OMAR",
        "middle_name": "HARBEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS106893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Elliott Jr., DACM, L.AC.
• Gina Elliott, M.A. CCC-SLP
• Dock Phillip Ellis III
• Hsiao Chien Ellis, L.AC.
• Jennifer Ellis, NP
• Gregory Elsky, PSY. D
• Elviga Home Health Inc
• Farnood Elyasian
• Sina Emami, MD
• Sanam Emanuel, PHARMD

• Dentist in Encino, CA
• Providers in Encino, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.