Provider Demographics
NPI:1619181450
Name:IRFAN DASTI DMD,PC
Entity Type:Organization
Organization Name:IRFAN DASTI DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DASTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,PC
Authorized Official - Phone:978-632-7870
Mailing Address - Street 1:394 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3926
Mailing Address - Country:US
Mailing Address - Phone:978-632-7870
Mailing Address - Fax:978-630-2601
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty