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Organization
ELLIS VILLAGE DENTAL GROUP, PROF. CORP.
Active
Organization
ELLIS VILLAGE DENTAL GROUP, PROF. CORP.
Active
Other names
Ellis Village Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
KHALED ENTABI DDS (OWNER)
(209) 395-2393
Entity
Organization
Contact information
Practice address
2100 ELLIS TOWN DR STE 105, TRACY, CA 95377-9033
(209) 395-2393
(209) 229-4303
Mailing address
PO BOX 660041, DALLAS, TX 75266-0041
(714) 845-8890
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/17/2026
Last updated
08/17/2026
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