MEDICARE: JASMINE DAHSHAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D010491	AZ

General Provider Information

NPI Number	:	1083270136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE DAHSHAN DDS

Provider Business Mailing Address
First Line	:	7170 W CAMINO SAN XAVIER STE C109
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-0862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 W PRINCE RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-5086
Country	:	US
Telephone Number	:	520-408-2288
Fax Number	:	520-408-3021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	02/27/2020

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