Provider Demographics
NPI:1497359558
Name:ESSMAT, AYA (DMD)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:ESSMAT
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 1:2829 S LAKELINE BLVD UNIT 821
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1801
Mailing Address - Country:US
Mailing Address - Phone:916-912-0027
Mailing Address - Fax:
Practice Address - Street 1:2829 S LAKELINE BLVD UNIT 821
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1801
Practice Address - Country:US
Practice Address - Phone:916-912-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice