Provider Demographics
NPI:1801621941
Name:EHSANI DENTAL PRACTICE
Entity type:Organization
Organization Name:EHSANI DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-277-8080
Mailing Address - Street 1:7695 CARDINAL CT STE 320
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-277-8080
Mailing Address - Fax:858-277-8090
Practice Address - Street 1:7695 CARDINAL CT STE 320
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-8080
Practice Address - Fax:858-277-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty