Healthcare Provider Details

I. General information

NPI: 1699813550
Provider Name (Legal Business Name): ALI EHSAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13805 PEMBERLEY PASSAGE AVE
BAKERSFIELD CA
93311-8745
US

IV. Provider business mailing address

13805 PEMBERLEY PASSAGE AVE
BAKERSFIELD CA
93311-8745
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-9681
  • Fax:
Mailing address:
  • Phone: 949-273-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: