=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043256621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASPIAN DENTAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 83 CAMBRIDGE ST SUITE 3A
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-221-7171
-----------------------------------------------------
Fax | 781-221-0171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 CAMBRIDGE ST SUITE 3A
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-221-7171
-----------------------------------------------------
Fax | 781-221-0171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KAMAND SHAIBANI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 781-221-7171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19601
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 19460
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------