Provider Demographics
NPI:1497819148
Name:DAFTARIAN, CHEESTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHEESTA
Middle Name:
Last Name:DAFTARIAN
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 1:2710 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2517
Mailing Address - Country:US
Mailing Address - Phone:979-776-2277
Mailing Address - Fax:979-776-2271
Practice Address - Street 1:2710 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2517
Practice Address - Country:US
Practice Address - Phone:979-776-2277
Practice Address - Fax:979-776-2271
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice