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Active NPI 1558051367 Individual Practitioner Male Practitioner

Ulises Ernesto Carballosa Fernandez

Dentist - General Practice • Ashtabula, OH

Professional Overview & Biography Verified Profile Summary

Ulises Carballosa Fernandez is a registered healthcare professional specializing in Dentist - General Practice in Ashtabula, OH. Practice services are available at 2203 LAKE AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

2203 Lake Ave

Ashtabula, OH 440043437

Telephone 4403818800

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Ashtabula, OH

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 19.6 Yrs
Regional Practice Density
15 Specialists

Practicing in Ashtabula, OH (4287 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-07-14
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License OH 30.028142

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

State License OH RES.004578

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Secondary Practice Locations

4071 Lee Rd Ste 260

Cleveland, OH 441282173

Phone: 2167271164

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location July 17, 2025

Registered at 2203 LAKE AVE, ASHTABULA, OH 440043437 (Tel: 4403818800)

📍
Updated Business Mailing Address July 17, 2025

Registered at 10803 LAKE AVE APT 104, CLEVELAND, OH 441021249 (Tel: 7866901609)

NPI Profile Active May 15, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location May 15, 2023

Registered at 4071 LEE RD STE 260, CLEVELAND, OH 441282173 (Tel: 2167271164)

📍
Updated Business Mailing Address May 15, 2023

Registered at 8201 BYRON AVE APT 305, MIAMI BEACH, FL 331414922

👤
Provider Name / Credentials Updated May 15, 2023

Recorded as ULISES CARBALLOSA FERNANDEZ

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 15, 2023

Student in an Organized Health Care Education/Training Program (License #RES.004578 in OH)

🟢
Initial NPI Registration & Enumeration May 15, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1558051367
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 15, 2023
Last Update: July 17, 2025
Sole Proprietor: Yes

Mailing Address

10803 Lake Ave Apt 104

Cleveland, OH 441021249

Phone: 7866901609

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.