Organization
OMAR ELOUSTAZ DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR HARBEY ELOUSTAZ DDS (CHIEF EXECUTIVE)
(818) 579-3351
Entity
Organization
Contact information
Practice address
16633 VENTURA BLVD STE 850, ENCINO, CA 91436-1846
(818) 990-5900
Mailing address
12040 NEENACH ST, SUN VALLEY, CA 91352-3043
(818) 579-3351
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
10/09/2023
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