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General NPI Number Information
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NPI Number | 1699813550
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Entity Type | Individual
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Provider Name | ALI EHSAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 13805 PEMBERLEY PASSAGE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93311-8745
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Country | US
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Telephone | 949-273-9681
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Fax |
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Provider Business Mailing Address
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Address Line | 13805 PEMBERLEY PASSAGE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93311-8745
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Country | US
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Telephone | 949-273-9681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52380
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 52380
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License Number State | CA
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