Healthcare Provider Details

I. General information

NPI: 1831027119
Provider Name (Legal Business Name): EHSANI CABRILLO DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 300
SAN DIEGO CA
92123-3357
US

IV. Provider business mailing address

7695 CARDINAL CT STE 300
SAN DIEGO CA
92123-3357
US

V. Phone/Fax

Practice location:
  • Phone: 858-289-1404
  • Fax:
Mailing address:
  • Phone: 858-289-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NADER EHSANI
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 858-289-1404