Provider Demographics
NPI:1770671265
Name:AFSHAR, EHSAN (DDS)
Entity Type:Individual
Prefix:
First Name:EHSAN
Middle Name:
Last Name:AFSHAR
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 1:3222 ROYAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8556
Mailing Address - Country:US
Mailing Address - Phone:530-677-4457
Mailing Address - Fax:530-677-6763
Practice Address - Street 1:3222 ROYAL DRIVE
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682
Practice Address - Country:US
Practice Address - Phone:530-677-4457
Practice Address - Fax:530-677-6763
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice