MEDICARE: DR. PROSHAT S SHAHRESTANY D.D.S.

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	1223G0001X	General Practice Dentistry	46217	CA

General Provider Information

NPI Number	:	1922277466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PROSHAT S SHAHRESTANY D.D.S.

Provider Business Mailing Address
First Line	:	2030 W AVENUE J
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-5913
Country	:	US
Telephone Number	:	661-949-6757
Fax Number	:	661-949-0558

Provider Business Practice Location Address
First Line	:	2030 W AVENUE J
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-5913
Country	:	US
Telephone Number	:	661-949-6757
Fax Number	:	661-949-0558

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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