Provider Demographics
NPI:1255079562
Name:ERSHADI, ASHKAN (DMD)
Entity type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:ERSHADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7391 RUTHERFORD HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-5204
Mailing Address - Country:US
Mailing Address - Phone:818-334-9821
Mailing Address - Fax:
Practice Address - Street 1:5784 LINDERO CANYON RD STE B
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4088
Practice Address - Country:US
Practice Address - Phone:818-706-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38338122300000X
CADDS108368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist