Healthcare Provider Details

I. General information

NPI: 1043256621
Provider Name (Legal Business Name): CASPIAN DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CAMBRIDGE ST SUITE 3A
BURLINGTON MA
01803-4181
US

IV. Provider business mailing address

83 CAMBRIDGE ST SUITE 3A
BURLINGTON MA
01803-4181
US

V. Phone/Fax

Practice location:
  • Phone: 781-221-7171
  • Fax: 781-221-0171
Mailing address:
  • Phone: 781-221-7171
  • Fax: 781-221-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19601
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19460
License Number StateMA

VIII. Authorized Official

Name: DR. KAMAND SHAIBANI
Title or Position: DENTIST
Credential: DMD
Phone: 781-221-7171