Provider Demographics
NPI:1831080142
Name:ELIE DDS INC
Entity type:Organization
Organization Name:ELIE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:ELIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-483-3039
Mailing Address - Street 1:148 FLYING MIST ISLE
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1402
Mailing Address - Country:US
Mailing Address - Phone:650-483-3039
Mailing Address - Fax:
Practice Address - Street 1:1289 E HILLSDALE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1219
Practice Address - Country:US
Practice Address - Phone:669-244-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental