Provider Demographics
NPI:1235512062
Name:EBY, SASHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:
Last Name:EBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4693 MORSE RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1375
Mailing Address - Country:US
Mailing Address - Phone:614-471-7800
Mailing Address - Fax:
Practice Address - Street 1:4693 MORSE RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1375
Practice Address - Country:US
Practice Address - Phone:614-471-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist