Provider Demographics
NPI:1376901371
Name:ERGASH, NASRIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NASRIN
Middle Name:
Last Name:ERGASH
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 1:3608 DALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0500
Mailing Address - Country:US
Mailing Address - Phone:209-577-0777
Mailing Address - Fax:
Practice Address - Street 1:4101 TULLY RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8980
Practice Address - Country:US
Practice Address - Phone:209-577-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist