MEDICARE: DR. PARIZAD EHSAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	42981	CA

General Provider Information

NPI Number	:	1700119161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARIZAD EHSAN DDS

Provider Business Mailing Address
First Line	:	1050 NORTHGATE DR
Second Line	:	SUITE 505
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2526
Country	:	US
Telephone Number	:	415-367-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 SOUTHRIDGE RD E
Second Line	:
City	:	BELVEDERE TIBURON
State	:	CA
Zip	:	94920-2115
Country	:	US
Telephone Number	:	415-367-5489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	10/28/2024

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