MEDICARE: DR. NADER EHSANI D.M.D.

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	8081	KY

General Provider Information

NPI Number	:	1871582700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADER EHSANI D.M.D.

Provider Business Mailing Address
First Line	:	12601 TOWNEPARK WAY
Second Line	:	STE.#100
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2302
Country	:	US
Telephone Number	:	502-326-8000
Fax Number	:	502-326-7900

Provider Business Practice Location Address
First Line	:	12601 TOWNEPARK WAY
Second Line	:	STE.#100
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2302
Country	:	US
Telephone Number	:	502-326-8000
Fax Number	:	502-326-7900

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	05/14/2010

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