Provider Demographics
NPI:1730675661
Name:NADER EHSANI DDS INC
Entity Type:Organization
Organization Name:NADER EHSANI DDS INC
Other - Org Name:SAN MARCOS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-744-4444
Mailing Address - Street 1:833 W SAN MARCOS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1112
Mailing Address - Country:US
Mailing Address - Phone:760-744-4444
Mailing Address - Fax:760-744-5087
Practice Address - Street 1:833 W SAN MARCOS BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1112
Practice Address - Country:US
Practice Address - Phone:760-744-4444
Practice Address - Fax:760-744-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty