Provider Demographics
NPI:1396209821
Name:EHSAN DIAB DENTAL COMPANY INC.
Entity type:Organization
Organization Name:EHSAN DIAB DENTAL COMPANY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-824-5011
Mailing Address - Street 1:1665 W SHAW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3508
Mailing Address - Country:US
Mailing Address - Phone:559-492-2486
Mailing Address - Fax:559-840-1469
Practice Address - Street 1:1665 W SHAW AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3508
Practice Address - Country:US
Practice Address - Phone:559-492-2486
Practice Address - Fax:559-840-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty