Provider Demographics
NPI:1083270136
Name:DAHSHAN, JASMINE (DDS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DAHSHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7170 W CAMINO SAN XAVIER STE C109
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1743 W PRINCE RD STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5086
Practice Address - Country:US
Practice Address - Phone:520-408-2288
Practice Address - Fax:520-408-3021
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist