Provider Demographics
NPI:1346545886
Name:DASTUR, ANAHITA TARAPOREWALLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANAHITA
Middle Name:TARAPOREWALLA
Last Name:DASTUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANAHITA
Other - Middle Name:BEHRAM
Other - Last Name:TARAPOREWALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:241 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3419
Mailing Address - Country:US
Mailing Address - Phone:626-852-3750
Mailing Address - Fax:
Practice Address - Street 1:241 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3419
Practice Address - Country:US
Practice Address - Phone:626-852-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry