=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619023694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DABESTANI DENTISTRY, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13910 N FRANK LLOYD WRIGHT BLVD SUITE 3
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-915-4800
-----------------------------------------------------
Fax | 623-915-5084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13910 N FRANK LLOYD WRIGHT BLVD SUITE 3
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-915-4800
-----------------------------------------------------
Fax | 623-915-5084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARDESHIR DABESTANI
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 623-915-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5130
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5049
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------