Provider Demographics
NPI:1649392150
Name:AGHASI, PAIMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAIMAN
Middle Name:
Last Name:AGHASI
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 1:16565 VANDERBILT DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7552
Mailing Address - Country:US
Mailing Address - Phone:239-992-0110
Mailing Address - Fax:239-947-6556
Practice Address - Street 1:16565 VANDERBILT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7552
Practice Address - Country:US
Practice Address - Phone:239-992-0110
Practice Address - Fax:239-947-6556
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist