Provider Demographics
NPI:1144608225
Name:DIAB, EHSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:DIAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 N CHESTNUT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0349
Mailing Address - Country:US
Mailing Address - Phone:559-475-0357
Mailing Address - Fax:
Practice Address - Street 1:7015 N CHESTNUT AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0349
Practice Address - Country:US
Practice Address - Phone:559-475-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist