Basic Information
| Provider Information | |||||||||
| NPI: | 1255079562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERSHADI | ||||||||
| FirstName: | ASHKAN | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7391 RUTHERFORD HILL DR | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913075204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183349821 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4610 NORTH ST STE 101B | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759651840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365600900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2022 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 38338 | TX | Y | Dental Providers | Dentist |
No ID Information.