Healthcare Provider Details

I. General information

NPI: 1366080905
Provider Name (Legal Business Name): OMNI ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 GEORGE DIETER DR STE B
EL PASO TX
79936-7681
US

IV. Provider business mailing address

1397 GEORGE DIETER DR STE B
EL PASO TX
79936-7681
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-9267
  • Fax: 915-248-3615
Mailing address:
  • Phone: 915-990-3636
  • Fax: 915-248-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SOHEIL KHODADADI
Title or Position: OWNER
Credential: DDS
Phone: 915-990-3636