NPI
Ellis Village Dental Group, Prof. Corp.
Doing business as Ellis Village Dental Group. Phone (209) 395-2393 · Fax (209) 229-4303 · NPI 1245145051
Read from the NPPES registry on October 24, 2026.
Facts
- Status
- Active
- Type
- Organization
- Enumeration date
- 2026-08-17
- Last updated
- 2026-08-17
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Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 2100 Ellis Town Dr Ste 105
- City
- Tracy CA
- Postal code
- 95377-9033
- Phone
- (209) 395-2393
- Fax
- (209) 229-4303
Organization contact
- Name
- Khaled Entabi
- Title
- Owner
- Phone
- (209) 395-2393
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.
Nearby
General Dentists in Tracy, CA. 64 with this primary taxonomy in the public file.
Other NPIs in Tracy, CA. 2,258 records in the public file.
Public data from NPPES and CMS. Not a credentialing determination.
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