Provider Demographics
NPI:1255469714
Name:DABESTANI, ARDESHIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:
Last Name:DABESTANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16816 N 35TH AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2977
Mailing Address - Country:US
Mailing Address - Phone:602-978-1932
Mailing Address - Fax:602-938-7407
Practice Address - Street 1:16816 N 35TH AVE STE 9
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2977
Practice Address - Country:US
Practice Address - Phone:602-978-1932
Practice Address - Fax:602-938-7407
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5049OtherSTATE LICENSE NUMBER