Provider Demographics
NPI:1033264163
Name:DASTI, IRFAN L (DMD PC)
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:L
Last Name:DASTI
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1519
Mailing Address - Country:US
Mailing Address - Phone:978-441-9991
Mailing Address - Fax:978-441-9996
Practice Address - Street 1:394 ELM ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3926
Practice Address - Country:US
Practice Address - Phone:978-632-7870
Practice Address - Fax:978-630-2601
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice