Healthcare Provider Details

I. General information

NPI: 1063664969
Provider Name (Legal Business Name): HUSSAIN M. DASHTI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100405
GAINESVILLE FL
32610-0405
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5801
  • Fax: 352-392-3070
Mailing address:
  • Phone: 352-273-6775
  • Fax: 352-392-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN 697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: