Provider Demographics
NPI:1427103993
Name:NASERY, EHSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:NASERY
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 1:7625 MESA COLLEGE DR
Mailing Address - Street 2:SUITE.100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5343
Mailing Address - Country:US
Mailing Address - Phone:858-514-4290
Mailing Address - Fax:858-514-4291
Practice Address - Street 1:7625 MESA COLLEGE DR
Practice Address - Street 2:SUITE.100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-514-4290
Practice Address - Fax:858-514-4291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice