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General NPI Number Information
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NPI Number | 1932889185
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Entity Type | Individual
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Provider Name | GHASSEM ANSARI DDS, MSC, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 08/25/2024
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-3006
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Country | US
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Telephone | 310-206-7597
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Fax | 310-825-9460
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE RM 23-019
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-206-7597
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Fax | 310-825-9460
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DRPM2639
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 319
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License Number State | CA
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