Healthcare Provider Details

I. General information

NPI: 1801621941
Provider Name (Legal Business Name): EHSANI DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 320
SAN DIEGO CA
92123-3357
US

IV. Provider business mailing address

7695 CARDINAL CT STE 320
SAN DIEGO CA
92123-3357
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-8080
  • Fax: 858-277-8090
Mailing address:
  • Phone: 858-277-8080
  • Fax: 858-277-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NADER EHSANI
Title or Position: PRESIDENT
Credential: DDS
Phone: 858-277-8080