Provider Demographics
NPI:1871582700
Name:EHSANI, NADER (DMD)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:EHSANI
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 1:12601 TOWNEPARK WAY
Mailing Address - Street 2:STE.#100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2302
Mailing Address - Country:US
Mailing Address - Phone:502-326-8000
Mailing Address - Fax:502-326-7900
Practice Address - Street 1:12601 TOWNEPARK WAY
Practice Address - Street 2:STE.#100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2302
Practice Address - Country:US
Practice Address - Phone:502-326-8000
Practice Address - Fax:502-326-7900
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice